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I 


THE 


CANADA  MEDICAL  RECORD 


A     JVIONTHIvY    JOTJRNAIv     OK 


Medicine,  Surgery  and  Pharmacy 


EDITORS  : 

A.  LAPTHORN    SMITH,  B.A.,  M.D.,  M.R.C.S.  Eng.,  F.O.S.  London. 
F.  WAYLAND  CAMPBELL,    M.A.,  M.D.,  L.R.C.P.  London. 

ASSISTANT     EDITOR: 

ROLLO  CAMPBELL,  CM.,  M.D. 


Volume  XXIII,  October,  180^,  to  September,  1895. 


BLISHED  BY  JOHN  LOVELL  &  SON 


CONTENTS  OF  VOLUME  XXIIT 


UHIOINAL    COTVIMUNICATIOJ^S. 

Cocaine  Poisoning 4ii 

Cceliotomy,  Three  Oases  of  :  An  Ovarian  Cyst ; 
A  Tubal  Pregnancy  ;  and  a  Hamatonia  of  tLe 

Ovary 'i5 

Consumption.  Home  and  Foreign  Climates  in. .193,  218 

Coroners'  Inquests,  Report  on 121 

Double  Femoral  Herniotomy  in  a  Woman  G4  years 

of  Age  ;  Primary  Union  of  both  Wounds .        28 

Fibroids,  The    Present  Status  of  the  Electrical 

Treatment  of 169,  241 

Fibroids  of  the  Uretus,  Abstract  of  a  Paper  en- 
titled   Observations   on  the  Treatment  of 145 

Goitre,  Recent  Eiectro-therapeusis  of,  with  Impro- 
vements in  Apparatus 97 

Medical  Practice,  A  Plea  for  Efficient  Legis- 
lation regulating  197,  218 

Obstetrical  Notes,  Some 73 

President's   Address,    Extract   of.  before     Nova 

Scotia  Medical  Society ' 28 

Psoriasis:  A  Clinical    Lecture 1 

Total  Hysterectomy,  Indications  for 176 

Uterine  Appendages,  The  Etiology  and  Treat- 
ment ot  Inflammations  of  the 196 

PROGRESS  OF   MEDICAL  SCIENCE. 

Acute  Infantile  Arthritis  in  the  Hip 281 

Aggressive  iSiirgery,  A  Case  of 185 

Alcoholism,  Nitrate  of  Strychnine  in 65 

Anrt'Sthesia .S8 

Animal  E.\tracts,  Some  Nevr 93 

Antipyrin  in  Large  Doses,  On  the  Use  of. 140 

Apocynum  Cannabinum  as  a  Cardio-kinetic  and 

Diuretic 207 

Appendicitis 11 

Appendicitis,  Diagnosis  of,  by  Palpation 141 

Appendicitis,  Diagnosis  and  Treatment  ol. 233 

Appendicitis,  Some  Recent  Views  on 157 

Ascites,  An  Extreme  Case  of 40 

Cancer  a  Local  Disease 38 

Cancer,  Electricity  for  Pain  of 13 

Cancer,  Etiology  of 12 

Cancer,  General  Treatment  of 13 

Cancer,  Lesions  ot  the  Stomach  Simulating 13 

Cancer,  The  Electrical  Cure  of. 14 

Cancer,  The  Parasites  of 13 

Cancer,  Houses  and  their  Victims  — 114 

Cancer  of  the  Breast,  Improved  Method  of  Ra- 
dical Operation  for 208 

CarcinomH,  Living  Parasites  in 14 

Chickens,  The  Immunization  of,  against  the  Dinh- 
theritic  Bacillus,  a:!d  the  Passage  of  Immuniz- 
ing substances  within  their  Eggs 284 

Chloral-Hydrate— Some  of  its  Uses 156 

Circumcision.  The  Neatest 233 

Class-Room  Notes 48,  162,192,  208, 

235,  238,  261,  264,  284 

Consumptives,  Homes  for i 39 

Cystitis,  The  Treatment  of 280 

Diabetes  Mellitus,  The  Treatment  of 89 

Diabetics,  The  Danger   of  Anajsthetizing 141 

Diarrhoea,  Salol  in 57 

Diphtheria,  An  Anomalous  Case  of 284 


Dii)htheria,  Bacteriological    Examinations  of,  in 

the  United  Slates 282 

Dipiitheria  in  Italy 283 

Diphtheria,  The  Antitoxin  Treatment  of... 59,  136,  109 

Diphtheria,  Treatment  of 283 

Diphtheria,  Treatment  of,  as  indicated  by  its  Etio- 
logy and  Pathology 284 

Diphtheria,  Cionp,  etc..  The  New  Cure  for 91 

Drugs,  Lowered  Duties  on GO 

Ear,  A  Unique   Foreign  Body  in  the 62 

Eczema  Ruhrum 62 

Eripyema,  Treatment  of 258 

Enema,  A  Novel   Way  of  Giving  an 60 

Enteric  Fever,  The  Urine  in  40 

Erythema  Multiform 61 

Face,  Tumor  of  the 261 

Fistula  in    Ano 139,  258 

Gall-Bladder,  Primary  Cancer  of  the 40 

Gastric  Affections,  Tlie  Stomach  Tube  in 184 

Gontirrhcea,  Boric  Acid   Injections  in 113 

Gonorrhoea,  New  Observations  in 38 

Gonorrhoea  in  Little  Girls,  Five  Cases  of 60 

Gonorrhoea,  The    Treatment  of,  by  Irrigation  of 

the  Urethra 87 

Growing  Pains 38 

Gullet,  Foreign    Body  in  the  ;  Subhyoid  Pharyn- 

gotomy  ;  Recovery 138 

Hemorrhage,  Torsion  of  Arteries  for   the  Arrest 

of •. 110 

Hemorrhoids,  A  Bloodless  O])eration  for 66 

Hemorrhoids,  Ouierbridge's  Operaiion  for 56 

Hemorrhoids,   The  Best   Treatment  of 42 

Hernia,  A  New    Operaiion  for  the  Radical    Cure 

of 233 

Hip  Joint  Disease,  Conservative  Treatment  of...  15 

Hydrocele,  A  New  Treatment  for Ill 

Hydrocele,  Treatment  of 38 

Hypertrophy  of  the  Prostate,  Castration  for 138 

Internal  Medicine,  The  Value  of  Chloroform  in...  139 

Kidnejr,  Malign  Tumors  of  the  120 

Ligatures,  New  Method  of  Sterilizing 2ii7 

Major  Amputations,  Technique  of 14 

Maladies  of  Children,   Treatment  of  Some  Fre- 
quent   258 

Malig-.iant  and  Non-Malignant  Tumor,  Local  Elec- 
trolysis and  Zinc  Amalgam   Cataphoresis  in...  234 

Meningitis  of  Obscure  Causation 160 

Middle  Ear,    Suppuration  of  the,  due  to  a  Coffee 

Bean  in  the   Nose 64 

Morton,  Wm.   Thos.  Green,  M.D 86 

Muscular   Work,  The    Value   of   Sugar  and   the 

Effect  of  Smokins  on 160 

Myopia,  The  Cause  and    Percentage  of .    ..  59 

Nocturnal  Enuresis,  Eye  Strain  a  Cause  of 282 

Noises,  iMunicipal  Control  of  Unnecessary  286 

(Esophagus,  Foreign    Body  in  the 63 

Opium  Among  the  Chinese,  Medical' 0;-inion  as  to 

the  Use  of .' 60 

Perinephritic  Abscess 257 

Perityphlitis,   Accentuation   of   the    Pulmonary 

Sound  in ^ 38 

Pernicious  AnaBihia  at  the  Age  of  Twenty-one...  160 
Phlegmasia  Alba   Dolens,    Potassium  Nitrate  in     . 

the  Treatment  of 140 

Placenta    Pra3via,  Treatment  of...; 185- 


CONTENTS. 


Pott's  Disease,  Treatment  of 158 

Prolapse   of  the    Rectum,  Pbysiological  Rest  in 

the  Treatraent  of  "'41 

Prostate  (?land,  Castration  in  Hypertrophy  of  the  113 

Rectal  Tube,  Danjcers  of  the  Lonp 42 

Recurring  Appendicitis,  Freedom  from,  after  Eva- 
cuation of  the   Abscess   and   Retention  of  the 

Appendix Ill 

Red  N'oso,    Treatment  of    41 

Renal  Calculus,  New  Method  of  Examining  for....  40 

Renal  Disease.  Treatment  of 92 

Renal  Hemorrhage  from  an  C^niisnal   Source 40 

Ruptnred    Gastric  Ul-er  successfully  treated  by 

Abdoraintl  Section  and  Suture 58 

Scalp,  Rinzworm  of  the til 

^cartet  Fever,  Septicemia  durinsr,  implicating 
several  Joints  and  Causing  Necrosis  of  the  Cla- 
vicle   63 

Sciatica,  The  Treatment  of 18-J 

Scorbutus  in  Infants : 161 

"^eminal  Vesiculitis.  Persistent  f-rethral  Dis- 
charges Due  to 232 

~-»rious  Hemorrhage,   Subcutaneous  Injection  of 

Artibcial  S-rura  in 161 

-evere  Albuminuria  associated  with   Pregnancy, 

Treatment  of. 136 

Skin  Grafting  of  Stump  after  Amputation  187 

Stomach  and  fE^ophigus  Catheterization  of  the.  188 

Strangulated  Hernia,  Treatment  of 156 

Stricture  of  the  (Esophagus, The  Treatment  of.....  232 

Successful  Warfare,  A 60 

Suppurative  Mastoiditis  from  Suppurative  Otitis 

Media 63 

Surgical  Practice,  Defects  in  208 

Surgical  Tuberculosis,  Venous  Stasis  in 15 

Syjihilis  of  the  Tongne  and  Cancer 16 

Syringes,  Second-hand 41 

Taenia  in  a  Child,  A  Case  of. 160 

Temlo  Acbillis,  A  New  Method  of  Shortening  the  233 

Therapeutic  Briefs 163,  259 

Therapeutics,  Recent  Suggestions  in 110 

Thyroid  Administration,  Effects  of. 156 

Tic  Uouloureu.x 66 

Tippling  62 

Tongue,  Removal  of  the,  tor  Cancer 17 

Traumatic  Cyst  of  the  Stomach,  Rare  Case  of.....  39 

Tubercular  Arthriiis,  Ignipuncture  in  04 

Tuberculosis  in  Children,  Diagnosis  of 156 

Tuberculosis,  The  Extinction  of 113 

Tuberculosis,  Unilateral  Sweating  in 257 

Tuberculous  Peritonitis,  Laparotomy  in 13 

Tumors.  Electrolytic  Trentmentof 138 

Typhoid    Fever,   The   Method   of  Brand   in  the 

Treatment  of 64 

Tyi>hoid  Fever,  Water  in 41 

Uterine  Cancer,  The  Early  Diagnosis  of. 13 

Varicocele,  Treatment  of 16 

Vomiting,  Acetanilide  for 138 

Vomiting  in  Children,  The  Treatment  of 185 

Wry  Neck.  Operative  Treatment  of 208 

EDITOKIAL. 


English  as  a  Universal  Language 

Hingston   Sir  William  H 

International  Language  of  the  Future, 'The 

Management,  Change  of 

.Medical  Council.  The 

Medical  Items 143, 

.Medical  Students,  The  Outlook  for 

Montreal,  Sanitary  Condition  of 

Murphy  Button,  The 

Naval  Surgeons,  Tne  Dutj'  of 

New  York  Academy  of  .Medicjne,  The 

Overcrowded   Professions ' 

Patent  .Medicines 

Pathological  Specimens,  The  E.xamination  of. 

Post  Graduate  Instruction  in  .Montreal 

Practitioner  of  St.  Louis,  The 

Private  Hospitals,  The  Advantages  of. 

Prostatic  Hypertrophy,  The  Rapid  Cure  of,  by 
Removal  of  the  Testes 

Province  of  Quebec  .Medical  Association,  A 

Quiet  Res'ing  Place,  A 

Samaritan  Hospital  for  Women,  The,  Montreal.... 

Sciences.  Abolish  the  Duty  on  Alcohol  for  Use  in 
the  

Selection 

Should  Patients  in  Private  Rooms  in  Piib'ic  Hos- 
pitals be    allowed  to  have    their  own  Doctor  ? 

Should  Phthisis  be  Stamped  out'.' 

Typhoid  <  ivster  Scare,  The  

Typhoid  Patients,  The    Diet  for 

Uterus.  Removal  of  the,  by  Enucleation  without 
Clamp  or  Ligature 

What  Doctors  Die  from    

SOCIETY  PUOCKEUINGiS. 

Academic  de  Medecine 

American  Association  of  Genito-Urinary. Surgeons 

American  Dermatological  Associatio  i 

American  Electro-Therapeutic  Association 46, 

Ameiican  Public  Health  Association 

Association  of -American  Physicians  

Berlin  Medical  Society 

British  Medical  Association 

College  of  Physicians  of  Philadelphia 

Congress  of  American  Physicians  and  Surgeons 

Eighth  French    Congress  of  Surgery 

Eighth  International  Congress  of  Demography 
and  Hygiene 

Eleventh  International  Aledical  Congress 

Kentucky  .School  of  Medicine 

Medical  and  Chirurgical  State  Faculty  of  Mary- 
land   

Midland  .Medical  Society 

Montreal  Medico-Chirurgical  Society  3,  31. 

.51,  76,  99,  127,  1.40,178,  199,  221,  24$; 

Rouen  Medical  Society : 

Societe  Francjaise  de  Laryngologie,  d'Otologie,  et 

de  Rhinologie 

Vienna  .Medical  Society • 


Acknowledgment-' 118 

American  Electro-Therapeutic  Asso<iation,  The..  238 

American  Medical  Association,  The 189 

Bequest,  A  Generous 69 

Bisjioii's  College 70  1 

Book  Reviews 94 

Buffalo  .Medical  Journal,  The 263) 

Buffalo  Medical  and  Surgical  Journal 191 

(Janada  Medical   Association 164 

Canadian  .Medical  Association 118,209,236,  285 

Canadian  .Medical  .Monthly,  The 69 

Canadian  Medieval  Review,  The 69,  117 

County    Societies 43 

Death  of  Oliver  Wendell  Holmes 45 

Diphtheria,  The  Anti-Toxin  Treatment    of 08,  115 

Docor's  Prescription  ?  Who  Owns  the   67 


BOOK  NOTICES,  1894-1895. 

Book  Notices, 22,  47, 

70,94,  118,  143   166,  191,  214,238, 

Pamphlets  received 23,47,72, 

96,  119,  168,  240,  '264. 

ANNOUNCEMENTS. 

American  Academy  of  Medicine 

Correspondence 

News  Items 


20 
189 
164 
285 
213 
166 
164 
262 

68 
1(15 
)65 
142 
165 

44 

69 
117 

2:^6 

18 
•19 
263 
142 

20 

238 

262 

115 

116 

19 

94 

209 


155 
106 
28(1 
182 

45 
109 

66 
107 

10 
110 
132 

134 
54 
42 

10 

132 


Personal -20,  263, 


Publishers'  Department 21,  24.48, 

72,96,  120,  144,  168,  192,  21<5,  240, 


265 
37 


106 
55 


286 

287 

131 
210 
264 

286 

288 


Vol.  XXIII. 


MONTREAL,  OCTOBER,  1894. 


No.  1. 


ORIGINAL  COMMUNICATIONS. 

Psoriasis  :  A  Cliuical  Lecture 1 

SOCIETY  PROCEEDINGS. 

The    .AUmtreal    Meilieo-Cliirurgical 

Society 3 

Chronic  Nephritis  in  the  Dog 3 

Angioma  and  Adenoma  in  a  Wood- 

chuclv ,    .  4 

(-)variau  Cyst ■i 

Tubal  Pregnancy .5 

Kpithelionia  of  tlie  Cervix  Uteri.  ...  6 
Blue   Coloration  of  the    Urine    fol- 
lowing the  use  of  Methylene  Blue.  G 

Carcinoma  of  the  Kectum 6 

Angiomata  of  the  Colon  .  7 

A  Case  of  Infection  by  the  Bacillus 

Pyccyaneus '. 7 

Mycetoma  Pedis 9 

Medical  and  Chirurgical  State  Fa- 
culty of  Maryland 10 

College  of   Physicians  of  Philadel- 
phia   10 


PROGRESS  OF  SCIENCE. 

■Viipendicitis 11 

Etiology  of  Cancer 12 

Laparotomy  in  Tuberculous  Perito- 
nitis    13 

The  Parasite  of  Cancer 13 

Lesions  of  the  Stomach  Simulating 

Cancer 13 

Electricity  for  Pain  of  Cancer 13 

General  Treatment  of  Cancer 13 

The  Early  Diagnosis  of  Uterine  Can- 
cer   13 

The  Electrical  Cure  of  Cancer 14 

Living  Parasites  in  Carcinoma 14 

Technique  of  ^Major  Amputations.  .  J4 
Venous  Stasis  in  Surgical  TuViercu- 

losis 1,5 

Conservative     Treatment     of    Hip 

Joint  Disease 15 

Treatment  of  V.aricocele lo 

Syphilis  of  the  Tongue  and  Cancer..  16 

Removal  of  the  Tongue  for  (,'anccr..  17 

EDITORIAL. 

The  Rapid  Cure  of  Prostatic  Hyper- 
trophy by  Removal  of  the  Testes. .  18 


The  Diet  for  Typhoid  Patients  19 

A  Province  of  Quebec  Medical  Asso- 
ciation   19 

English  as  a  Universal  Language.. . .  20 
Abolish  the  Duty  on  Alcohol  for  use 

in  the  Sciences '20 

Personal 20 

Literary  Notes 21 

BOOK  NOTICES. 

^Manual  of  Obstetrics,  Gyntecology 
and  Pediatrics 22 

A  New  Illustrated  Dictionary  of 
Medicine,  Biology,  and  Collateral 
Sciences 22 

Atttield's  Chemistry 22 

A  Treatise  on  the  Principles  and 
Practice  of  Medicine 23 

The  Graphic  History  of  the  Fair....    23 

Pamphlets  received 23 

Publishers  Department 24 


Sriijfnal    tfommuntcations. 

PSORIASIS  :  A    CLINICAL    LEC- 
TURE. 
By  William  S.    Gottheil,    M.D.,   Der- 
matologist   to  the   Lebanon  Hospital,  the 
North-  Western    and   the  German  West- 
Side  Dispensaries,  N.Y. 
Genti-EMEN  : — The  patients  that  I  show 
you    to-day    are  classical  examples    of  a 
common  disease,  and  are  on  that  account 
perhaps  more  worthy  of  our  attention  than 
those  rarer  affections  that  but  very  seldom 
come  to   the  notice  of  the  general  practi- 
tioner.    And   they  will  serve  me  as  a  text 
in    calling  your  attention  to    certain    new 
and  very  eligible  forms  of  treatment  that 
have  been  developed  in  the  last  few  years, 
and    which    have   largely  superseded    the 
older  methods. 

The  first  patient  is  an  excellent  example 
of  a  general  guttate  psoriasis,  psoriasis 
universalis,  in  a  female  33  years  of  age. 
She  has  had  the  malady,  to  her  own  re- 
collection, ever  since  her  fifth  year, — the 


usual  history  of  these  cases,  though  it  does 
occur  de  novo  even  in  advanced  age,  and 
the  defective  memory  and  carelessness  of 
our  dispensary  cases  often  lead  them  to 
claim  that  the  present  is  their  first  attack, 
It  has  been  constantly  present,  in  some 
degree,  ever  since  the  patient  can  recollect ; 
at  times  almost  disappearing,  and  then, 
under  influences  that  we  are  ignorant  of 
advancing  and  spreading  over  the  body 
until  it  occupies  areas  as  extensive  as  that 
jvhich  you  see  affected  at  the  present  time. 
Her  entire  body  is  covered  with  white, 
scaly  spots,  looking  very  much  as  if  some 
molten  waxy  material  had  been  liberally 
sprinkled  on  it  with  a  large  brush.  Each 
spot  consists  of  a  heaped  up  mass  of  sil- 
very epidermic  scales,  which  can  be  readily 
removed  with  the  finger-nail,  leaving  a 
reddish,  slightly  elevated  papule  behind, 
at  points  of  which  the  torn  tops  of  the 
papillae  of  the  skin  show  as  minute  bleed- 
ing points.  The  scales  are  lamellae  of 
fused  epidermic  cells,  and  their  peculiar 
silvery  appearance  is  due  to  presence  of 
air  between  them. 


THE  CANADA  MEDICAL  RECORD. 


The  entire  surface  of  the  body  is  sprin- 
kled with  these  guttw  ;  but  in  certain  locali- 
ties, and  more  especially  on  the  flexor 
surfaces  of  the  joints  of  the  extremities, 
they  are  most  abundant,  and  form  more  or 
less  continuous  scaly  masses  with  but  little 
healthy  skin  between  them.  So  abundant 
is  this  scaling  that  the  patient  scatters  a 
cloud  of  minute  lamellae  round  her  as  she 
moves  when  stripped,  and  several  large 
handfuls  can  be  gotten  from  her  clothing. 
The  epidermic  proliferation  is  quite  rapid 
in  these  cases  ;  but  it  is  only  on  parts  not 
often  washed  that  it  occurs  to  so  great  an 
extent  as  you  see.  On  the  face  and  hands, 
where  soap  and  water  have  not  been  quite 
so  sparingly  employed,  there  are  no  scales 
at  all,  only  the  low  reddish  papules  mark 
the  existence  of  the  disease.  It  is  import- 
ant to  note  this  fact,  for  in  some  cases, 
where  the  disease  is  not  extensive,  the 
patients  have  removed  all  the  scales  before 
they  come,  and  the  apparent  absence  of  so 
characteristic  a  symptom  may  lead  to  an 
error  in  diagnosis.  The  scalp  is  covered 
with  more  or  less  confluent  psoriatic 
patches,  but  the  palms  and  soles  are  free. 

The  second  case  is  a  male  of  about  the 
same  age,  with  a  very  different,  but  just  as 
characteristic  disease  appearance.  Only 
the  knees  and  elbows  are  affected.  Each 
of  these  surfaces,  where  the  skin  is  natur- 
ally thicker  and  rougher  than  on  other 
portions  of  the  body,  shows  a  more  or  less 
extensive  infiltrated  patch,  with  apparently 
but  little  scaling;  but  scraping  reveals  the 
characteristic  lanicllas.  Here  also  the 
condition  has  existed  for  many  years ; 
the  scaly  infiltrated  patches  disappear  at 
times,  espcciall}-  during  the  hot  weather; 
but  they  always  reappear  during  the  winter. 

Both  patients  are  evidently  in  good 
health, — in  fact,  most  psoriatic  patients  are 
robust,  even  when  the  disease  is  very  ex- 
tensive. Its  cause  is  absolutely  unknown. 
Heredit)-  certainlj-  plays  no  part  in  it.  It 
may  be  of  parasitic  origin  ;  but  no  microbe 


has  been  found.  The  Epidermophyton 
described  by  Langer  is  certainly  not  the 
etiological  factor. 

It  is  to  the  treatment  of  these  cases, 
however,  that  I  would  call  }our  special 
attention.  Internal  medication  is  of  the 
greatest  importance,  especially  in  cases  so 
extensive  as  our  first  one.  Arsenic  ,so  little 
employed  by  the  dermatologist,  is  undoubt- 
edly of  use  here,  German  opinion  to  the 
contrary  notwithstanding,  but  it  must  be 
taken  regularly,  and  in  large  doses,  for  a 
long  time.  It  is  therefore  better  gi\en  in 
the  pill  form.  Ichthyol  is  also  beneficial, 
and  we  will  put  both  patients  on  a  combi- 
nation of  the  two,  using  a  modification  of 
the  famous  "  Asiatic  Pill,"  which  is  a 
favorite  formulae  of  mine : 

R.     Ammon.  Sulph-ichthyolat.     3  ii. 
Acid.  Arseniosi,  gr.  iii. 

Pulv.  Pip  Nig.,    ,  d  iii. 

Pulv.  Glyc,  Rad.,  0  iii. 

M.  Ft.  pil.  No.  90. 

One  of  these  is  to  be  taken  three  times 
daily,  after  meals.  The  amount  of  arsenic 
may  be  gradually  increased  until  a  max- 
imum dose  of  1-20  or  1-15  grain  is  at- 
tained. 

Local  treatment,  however,  is  of  even 
greater  importance  than  internal  medica- 
tion. It  is  essential  in  all  cases,  and  is 
especially  important  when  the  face  and 
hands  are  affected  with  the  disease.  The 
deformity  must  be  removed  as  rapidly  as 
possible. 

Our  local  treatment  will  diftcr  in  the 
two  cases.  In  the  first  and  general  one  it 
should  be  systematic  and  thorough,  and  it 
ma}'  be  summarized  as  follow  s  : 

1.  Daily  general  bath  of  hot  water  and 
green  soap.  The  scales  must  be  entirel}- 
cleaned  oft"  from  the  surface  of  the  bod}-, 
to  permit  the  appliance  of  topical  remedies. 

2.  y\fter  leaving  the  bath,  jiaiiit  each 
spot  with  : 

1!.     01.  Rusci,  or  01.  cadini,       7   ii 
Spirit.  \ini, 


THE   CANADA    MEDICAI>    RECORD. 


Aetheris,  aa  3  iv 

Spirit.  Lavandulae,         gtt.  x. 

3.  Return  to  the  bath,  and  remain  there 
half  an  hour. 

4.  After  drying,  paint  each  spot  with 
the  following: 

5.  Arthrarobin,  or  chrysarobin,  i  part. 
Liquor  gutta    perchtu,    or  flexible 

Collodion,  10  parts. 

Arthrarobin  is  not  quite  so  effective  as 
chrysarobin  ;  but  it  is  safer.  It  may  be 
employed  over  the  entire  body,  whilst 
chrysophanic  acid  must  not  be  used  on  the 
face  or  hands,  not  only  on  account  of  the 
very  dark  staining  of  the  skin  that  it  causes, 
but  also  on  account  of  the  likelihood  of  its 
causing  the  disagreeable  and  even  danger- 
ous "  Chrysarobin  Conjunctivitis."  If  we 
decide  to  use  it,  the  Ungt.  Hydrargyri 
Ammoniati  must  be  employed  on  the  face 
and  hands. 

By  this  means  the  inuncting  of  the  whole 
body  with  disagreeable  ointments,  the  use 
of  cloths  and  bandages,  and  all  the  nasty 
paraphernalia  of  the  regular  ointment  treat- 
ment is  avoided  ;  and  the  clothing,  inevit- 
ably ruined  in  the  older  methods,  is  in  no 
way  harmed.  The  evaporation  of  the 
etherial  and  alcoholic  vehicles  of  the  reme- 
dies leaves  them  in  a  thin  and  hard  layer 
on  the  skin,  and  their  penetration  in  these 
solutions  is  at  least  as  great  as  when  sus- 
pended in  the  ordinary  fatty  vehicles. 

The  local  treatment  of  the  second  case 
is  more  simple.  We  now  possess  in  the 
Unguenta  Extensa,  CoUemplastra,  and  the 
Plaster  Mulls,  a  variety  of  very  eligible 
preparations  which  are  really  ointments 
spread  on  plaster,  and  so  combined  with 
the  basis  that  they  can  be  used  and  ap- 
plied like  ordinary  rubber  plaster.  We 
simply  take  some  of  the  10  per  cent.  Chry- 
sarobin plaster  mull,  cut  a  piece  to  accu- 
rately cover  the  psoriatic  spots,  and  apply 
them.  They  fit  accurately  to  the  parts, 
need  no  cloths  or  bandages  to  hold  them 
in  place,    do  not  soil   the   clothing,    and, 


above  all,  limit  the  action  of  the  remedy 
exactly  to  the  diseased  area.  We  will 
direct  the  patient  to  renew  these  plasters 
daily  until  the  patches  are  cured. 

Shall  we  succeed  in  curing  our  cases  .-' 
Yes,  for  the  time  being,  Every  spot  of 
psoriasis  will  disappear  from  the  skin  ;  but 
others  will  come  back  in  time  to  take  their 
place. 

25  West  53rd  Street, 
New  York  City. 


jacictg    8r0ccebin$s. 


THE  MONTREAL  MEDICO-CHIRURGI- 
CAL  SOCIETY. 

Stated  Meeting,  June  ist,    1894. 

J.  B.  McCONNELL,  M.D.,  2ND  VICE-PrESIDENT, 

IN   THE  Chair. 

Dr.  S.  R.  Mackenzie  was  elected  an  ordinary 
member. 

Chronic  Nephritis  in  the  Dog. — Dr.  Adami 
exhibited  specimens,  and  gave  the  results  of 
his  examination  of  a  case  of  chronic  interstitial 
nephritis  in  a  dog,  submitted  to  him  by  Dr. 
Wesley  Mills.  The  two  kidneys  differed  in 
size,  the  right  being  the  larger,  and  to  the 
naked  eye  presented  the  condition  well  known 
as  chronic  interstitial  nephritis.  The  capsules 
in  both  were  thickened  ;  they  peeled  off  with- 
out great  difficulty,  revealing  a  nodular  surface 
beneath.  They  cut  firmly  :  the  sections  show- 
ing dilated  pelves,  and  the  cortex  varied  in 
thickness,  in  some  places  corresponding  to  the 
depression  of  the  surface,  and  was  almost 
entirely  atrophied  ;  that  of  the  right  kidney, 
on  the  whole,  appeared  less  affected  than  that 
of  the  left.  Microscopical  examination  re- 
vealed a  condition  similar  to  that  seen  in  chro- 
nic  interstitial  nephritis  of  man.  There  was  a 
general  fibrosis  of  the  medulla,  with  occasional 
tubules  containing  traces  of  uratic  deposit, 
while  the  pelvis  of  the  left  kidney  contained  a 
m.inute  calculus.  The  ureters  in  both  had 
rather  thickened  walls,  but  neither  in  these  nor 
in  the  bladder  was  there  found  any  evidence 
pointing  towards  an  obstruction  to  the  flow  of 
urine 

Commenting  on  the  existence  of  this  disease 
in  the  dog.  Dr.  Adami  remarked  that  while  in 
his  experience,  as  well  as  in  that  of  Dr.  Mills, 
it  was  of  rather  rare  occurrence,  yet  it  was  easy 
to  conceive  causes  for  its  production  ;  inasmuch 
as  the  factors  of  excessive  inception  of  nitro- 
genous food,  coupled  with'insufficient  exercise, 
which  are  recognized  causes    of  the   condition 


THE  CANADA  MEDICAL  RECORD. 


in  man,  are  both  apt  to  prevail  in  the  Hfe  of  a 
dog.  There  is  a  "tendency  towards  fibroid  ' 
valvular  change  frequently  observed  in  dogs,  ' 
but  arterial  sclerosis  he  had  never  observed. 
In  over-fed  dogs  an  eczematous  condition  of  the 
skin  is  not  uncommon,  and  taking  these  indi- 
cations of  the  gouty  diathesis  into  considera- 
tion, he  was  inclined  to  believe  that,  if  cirrhosis 
of  the  kidney  in  dogs  was  not  often  recognized, 
it  was  because  careful  autopsies  have  not  been 
performed  in  sufficient  number. 

Dr.  Wesley  Mills  had  received   these  kid- 
neys   from    Dr.   Darling,   a    graduate  of  the 
Faculty  of  Comparative  Medicine,  who  thought 
the   condition    very   rare,     and  published   an 
account  of  the  case  in  \X\q  Journal  of  Compar- 
ative Medicine,  which  report  Dr.  Milfs  read  in 
detail.     Commenting   on    the  case.    Dr.    Mills 
remarked  that  although  diseases  of  the  kidneys 
are  considered  of  rare  occurrence  amongst  the 
lower  animals,  systematic  autopsies  are  not  by 
any  means  frequent,    especially  in  the  case  of 
the  dog.     He  was   impressed  with  the  truth  of 
Dr.  Adami's  view  of  the  case,  as  seen    by  the 
history ;  this   animal  was   fed   on    flesh    three 
times  daily,  and  had  a   hypertrophied  left  ven- 
tricle.    Moreover,  it   is   well  known    that  dogs 
are  very  susceptible  to  rheumatism,  and  rheu- 
matism is  allied  to  gout.     The  skin  of  the  dog 
is  easily  disordered,  and  almost  every  ailment 
he  is  subject  to  expresses  itself  by  some  abnor- 
mal condition  of  that  portion  of  his  anatomy. 
In  reply  to  a  question   of  Dr.  Reed  as    to 
whether   albuminuria   ever  occurred   amongst 
dogs,  Dr.  Mills  remarked  that  the  matter  had 
never  been  much   looked  into  owing  to    the 
great  difficulty  of  catheterizing  dogs.     He  had 
worked  upon  the  urine  of  dogs,   and  he   could 
say,  as  to    healthy  animals,    that   there  was   a 
certain  amount  of  uric  and  oxalic  acids  as  well 
as  a  great  deal  of  sulphates  in  the  normal  urine. 
An^iovia  and  Adeiioma  in    a  WoodcJiuck. — 
Dr.  Adam  I  showed    the  liver  of  a  woodchuck, 
which  had  also  been  sent  him  for  examination 
by  Dr.  Wesley  Mills.     At  the   right    extremity 
of  the  organ    a   tense   bulging  could    be   seen 
which  extended  deeply   into    its    substance,  as 
well  as  behind,  below,  above,  and  in  front  of  it. 
Upon  cutting  into  this  mass,  it  was  seen  to  be 
slyirply  circumscribed,    somewhat   paler    than 
the  normal  liver  tissue,  with    here  and   there 
spots  of  a  deeper  tint,  marking    haemorrhages 
or  dilated  vessels.     Microscopical  examination 
of  the  tumor    revealed    different  conditions  in 
the  periphery  and  the    central  portions.     The 
peripheral  specimens    showed  adenoma    of  the 
liver  cells,  not  biHary  adenoma   which  is  more 
common  in  man,  but  an  overgrowth  ofthelivcr 
cells  i)roper  which,  however,  were  not  regularly 
arranged  in  lobes  with  the  bile  ducts  separating 
and  encircling  them,  as  in  normal    liver,  but 
more  scattered.  '  The  central  portion    of   tlic 
tumor  sliowod,  in  addition  to  the  h;einorrhages 


already  noticed,  dilated  vessels  and  cavernous- 
like  spaces,    characteristic    of  angioma.     The 
combination  of  the  two  conditions  then,  ade- 
noma and  angioma,  make    it  extremely  inter- 
esting as  well  as  rare.     Comparing    this    with 
analagous  conditions  foimd  in  the  human  liver, 
Dr.  Adami  remarked  that    in  man  the  liver   is 
perhaps  the  most    frequent  seat  of  angiomata; 
but  a  combined  condition  as    we  have  here  is 
very  unusual    in  the   lower  animals,    the  ten- 
dency is  to  have  adenoma  develop  rather  than 
carcinoma  ;  and  that  the   former  is  the  condi- 
tion here  seems  confirmed  by  the  well  defined 
outlines  of  the  tumor  and  the  absence   of  any 
sign  of  infiltration  into  the  surrounding  tissue. 
Dr.  Wesley  Mills  remarked  thai  the  wood- 
chuck  in  question  was    one  of  the  animals  he 
had  been  rearing  and   studying   with  a  view  to 
arrive  at  some  sounder  knowledge  on  the  ques- 
tion of  hibernation.     This    was  the  one  which 
did  not  hibernate.     He  obtained  it  when  quite 
young,  and  kept  it  for  three  years,  and  without 
ever   having    shown   any    symptoms   of  being 
unwell  it  was  found  dead  one   morning  in  the 
cage.     At  the  post-mortem    he  noticed  a  dark 
mass  standing  out  in  the  folds  of  the  mysentery 
connected  with  the  liver  ;  there  seemed  to  have 
been     considerable    haemorrhage     which     he 
thought  was    the  cause   of  the   sudden  death. 
At  the  same  time  it  may  be    noted  that  it  died 
in  the  spring,  a   season  when    these   animals' 
vitality  is  at  its  lowest,  and  but  little  is  required 
to  end  their  career. 

Dr,  Lafleur  wished  to  know  why  Dr. 
Adami  considered  adenomata  of  the  liver  very 
rare  in  man.  Although  he  himself  only  re- 
membered having  seen  one  case  of  such,  yet 
quite  a  number  of  these  tumors  had  been 
reported,  and  the  condition  seemed  to  be 
common  in  France. 

Dr.  Adami  in  reply  said  that  the  cases  of 
adenomata  reported,  as  well  as  he  could  recol- 
lect, were  only  biliary  adenomata  ;  not  adenoma 
of  the  liver  cells  as  in  this  case. 

Ovarian  Cyst. — Dr.  Adami  exhibited  a  large 
ovarian  cyst  received  from  Dr.  Alloway.  It 
consisted  of  an  enormous  sac,  within  which 
were  secondary  sacs,  or  daughter  cysts,  and 
was  a  typical  example  of  an  ovarian  cystoma, 
the  interest  in  the  specimen  being  in  the  one 
huge  sac. 

D;.  Alloway  stated  that  the  patient  was  an 
old  woman,  6i  years  of  age,  and  was  remark- 
alile  for  the  activity  which  she  showed  con- 
sidering her  age  and  the  enormous  distension 
of  her  abdoman.  She  complained  of  no  pain, 
but  suffered  from  a  complete  procidentia  of  the 
pelvic  contents.  It  was  this  latter  condition 
which  first  led  Dr.  Alloway  to  doubt  the  prim- 
al y  diagnosis,  that  the  tinnor  was  connected 
with  the  livt-r,  and  on  further  investigation  he 
foimd  he  could  separate  the  border  of  the  livcr 
I  from  the  ui)per  portion  of  the  tumor  ;   the  dull 


TITK   CANADA   MEDTCAL  KECORT>. 


5 


note  over  the  tumor  was  continued  into  the 
pelvic  cavity.  The  doubt  as  to  diagnosis  was 
the  most  interesting  feature  in  the  case. 

Ovarian  Cyst. — Dr.  Adami  showed  a  second 
specimen  of  an  ovarian  cyst  received  from  Dr. 
Alloway.  This  also  showed  secondary  cysts, 
but  not  so  highly  developed  as  in  the  former 
case.  There  seemed  to  have  been  a  certain 
amount  of  inflammation  about  the  main  sac. 
Dr.  Alloway. — The  patient  was  an  unmar- 
ried woman,  40  years  of  age,  who  had  been 
suffering  from,  and  been  under  treatment  for 
the  last  six  months,  for  recurring  attacks  of 
pelvic  inflammation.  Recently  the  abdomen 
began  to  enlarge  very  much,  and  seeking  ad- 
vice, a  diagnosis  of  ovarian  tumor  was  made. 
The  whole  cyst  wall  was  united  to  the  parietal 
peritoneum,  and  in  some  places  to  the  intes- 
tines. These  adhesions  were  very  dense  and 
had  to  be  separated  inch  by  inch,  thereby 
increasing  greatly  the  difficulty  of  the  operation. 
The  intestines  were  of  the  color  of  port  wine, 
and  the  coils  were  united  together  by  a  soft 
gelatinous  material,  which  was  easily  broken 
down  without  injuring  the  bowel.  This  latter 
condition  Dr.  Alloway  had  never  before  seen 
in  abdominal  sections,  and  thought  it  might 
have  been  the  result  of  the  very  recent  periton- 
itis. 

Tubal  Pregnancy. — Dr.    Alloway  gave  the 
following    history :     The    patient,    a   lady    28 
years  of  age,    had  four  or  five    miscarriages, 
never  having  a  full   term  child.     She   had  her 
last  miscarriage  about  six  weeks  ago,  which  was 
followed  by  a  metrorrhagia  of  three  weeks'  stand- 
ing.    He  found  the  parts  so  exquisitely  tender 
as  to  preclude   exact  diagnosis,    at  the    same 
time  he  came  to  the    conclusion  that  there  was 
some  mass  growing   upon    the  left  side   of  the 
uterus,  and  that  the  interior  needed  curetting. 
The  curetting  he  first  performed,  and  while  the 
patient  was  under   ether   he  made  a    thorough 
examination  with  a  view  to  ascertain  the  nature 
of  the  growth  to  the  left  of  the  uterus.     This 
seemed  to  be  in  the  broad  ligament,  'and  as  the 
idea   of  tubal    fretation     presented    itself,    he 
advised  an  immediate  operation  for  its  removal. 
One  week  later  the  patient  was  again  put  under 
ether  and  the  abdomen  opened,     h.  large  mass 
was  noticed  coming  up  on    the  left  side,  which 
shoved  the  uterus  to   the   right.     It   was  of  a 
dark  bluish  color,  hard  in  parts,  while  in  other 
parts  it  had  the  feel  of  a  cyst   filled  with  fluid. 
The  sigmoid  flexure  of  the  large  intestine  had 
become  adherent  to  the   tumor   which  it  com- 
pletely encircled,  and  entered  the  pelvis  by  the 
right  instead  of  the  left  side.     The  ovary  was 
not  distinguishable  but  was    part  of  the  tumor 
mass.     The  mass  was  removed,  and  the  patient 
has  done  very  well,  and  is  now  almost  conval- 
escent.    The  condition   here  could  not  be  dis- 
tinguished from  a     hoematoma  of  the    ovary, 
which    condition  it   really    was,    but,    in    his 


o[)inion,  it  was  likely  to  be  caused  by  a  ruptured 
tubal  pregnancy. 

Dr.  Armstrong  said  he  had  now  seen  quite 
a  number  of  extra-uterine  flotations,  and  his 
experience  was  that  the  clinical  history  in 
these  cases  has  been  anything  but  uniform  and 
clear.  In  none  of  his  cases  has  he  seen  that 
clear  clinical  history  which  the  text  books  laid 
down.  There  is  often  no  definite  history  of  a 
skipped  menstrual  period,  no  severe  pain,  no 
condition  of  collapse  indicating  a  serious  inter- 
nal ha^moirhage.  This  indefinite  element  in 
the  history  should  always  be  borne  in  mind, 
as  many  of  those  cases  if  neglected  will  likely 
go  on  to  a  second  rupture  which  must  prove 
fatal.  Whenever  there  is  a  localized  mass  on 
one  side  of  recent  occurrence,  Dr.  Armstrong 
thought  the  matter  should  be  thoroughly  inves- 
tigated with  a  view  to  exclude  extra-uterine 
foetation. 

Dr.  J.  C.  Cameron  wished  to  know  upon 
what  data  Dr.  Alloway  has  based  his  diagnosis 
of  extra-uterine  foetation  ? 

Dr.  Alloway  in  answer  said  that  the  patient 
•  had  gone  three  weeks  over  a  menstrual  period  ; 
when  the  flow  did  commence  there  was  no 
history  of  any  clots  or  solid  masses  being 
passed,  nothing  but  a  constant  trickling  flow 
of  blood  ;  there  was  also  a  history  of  a  sudden 
acute  attack  of  pelvic  inflammation  accom- 
panied by  a  certain  degree  of  collapse — not 
the  collapse  due  to  a  large  haemorrhage,  but 
the  collapse  accompanying  shock .  This  acute 
inflammatory  attack  was  passed  over  very 
lightly  at  the  time,  being  regarded  as  some 
transient  alteration  in  the  bowel.  But  when 
taken  in  connection  with  the  missed  menstrua- 
tion, and  the  mass  to  the  left  of  the  uterus.  Dr. 
Alloway  thought  there  was  an  abundant  evi- 
dence of  extra-uterine  pregnancy.  The  opera- 
tion moreover  confirmed  his  diagnosis,  inas- 
much as  a  hoematoma  of  the  ovary  is  a  very 
rare  condition,  and  the  failure  to  find  a  foetus 
proves  nothing,  since  in  those  cases  where  we 
have  very  early  foetation,  no  evidence  of  the 
embyro  proper  is  found. 

Dr.  J.  C.  Cameron  believed  it  to  be  rare  for 
pregnancy  to  have  existed,  for  the  ovum  to  have 
attached  itself  to,  and  grown  in  the  tube  or 
uterus  without  leaving  some  evidence  of  the 
fact  behind.  Unless  one  could  produce  some 
such  evidence,  he  did  not  think  they  were  jus- 
tified in  pronouncing  and  reporting  it  as  a  case 
of  extra-uterine  pregnancy.  The  symptoms  of  in- 
flammation and  shock  upon  which  Dr.  Alloway 
lays  such  stress  are  just  as  fully  symptoms  of 
ovarian  htematoma  as  of  extra-uterine  preg- 
nancy. 

Dr.  Adami, while  admitting  that  Dr.  Cameron's 
remarks  were  in  some  respects  well  founded,  he 
yet  wished  to  suggest  the  possibility  that  after 
all  it  might  not  be  so  easy  to  detect  foetation  by 
,he   miscroscope.     He   referred  to   the   recent 


THE  CANADA  MEDICAL  RECORD. 


case  reported  by  Dr.  Armstrong,  in  which  pla- 
cental and  fcEtal  tissue  were  sought  for  in  vain, 
and  in  which  a  diagnosis  of  extra-uterine  preg- 
nancy was  arrived  at  by  the  finding  of  a  curious 
little  malformed  body  like  a  foetus.  Here  sup- 
pose, which  is  not  unlikely,  this  foetus  had  been 
lost,  or  passed  out,  or  absorbed,  no  evidence 
would  have  remained  of  the  abdominal  foeta- 
tion. 

EpHhclioma  of  the  Cervix  Uteri. — Dr.  Allo- 
w'AY  next  produced  a  photograph  of  a  case  now 
under  his  care  in  the  General  Hospital.  The 
woman  was  operated  upon  about  lo  days  ago 
for  a  malignant  growth  of  the  uterus,  accom- 
panied by  a  constant  discharge,  which  had  last- 
ed for  the  past  six  or  eight  months.  The  mass 
was  as  large  asachild's  head  at  the  seventh  or 
eighth  month, it  filled  the  whole  of  the  vagina,  and 
protruded  without,  as  seen  by  the  photograph. 
It  was  quite  friable,  easily  broken  down  with  the 
fingers,  and  was  of  the  ordinary  cauliflower 
variety  of  malignant  diseases.  It  extended  up 
as  far  as  the  posterior  fornix  of  the  vagina,  with- 
out greatly  implicating  the  latter's  walls  ;  and  ex- 
amination through  the  vagina  showed  the  broad 
ligament  to  be  affected.  On  account  of  the  latter 
complication  the  uterus  was  not  removed,  but 
instead  a  considerable  portion  of  this  tumor 
was  cut  away,  to  the  great  relief  of  the  patient, 
and  before  her  discharge  from  the  hospital  he 
hoped  to  remove  still  more  of  it.  The  interest 
m  the  case  lies  in  the  size  and  protrusion  of  the 
malignant  growth. 

Dr.  Adami, referring  to  this  case,  said  that  from 
the  distinct  cauliflower  appearance  of  the  mass 
one  would  have  suspected  epithelioma  ;  sections, 
however,  showed  it  characteristic  of  carcinoma 
instead  of  epithelioma.  It  is  richly  cellular,  and 
most  probably  originated  from  some  of  the 
mucous  crypts  rather  than  the  epithelium  of 
the  cervix. 

Blue  Coloration  of  the  Urine  follcwing  the 
use  of  Methylene  Blue. — Dr.  Adami  exhibited 
several  specimens  of  urine  of  a  deep  bluish  green 
tint,  from  a  patient  under  the  care  of  Dr.  Rod- 
dick. She  was  a  Jewess,  aged  d^y  and  came 
complaining  of  a  sore,  with  swelling,  upon  the 
leg.  She  stated  that  she  was  diabetic,  and  upon 
bringing  a  sample  of  her  urine,  Dr.  Roddick 
tho\ight  that  the  bottle  was  not  clean,  but  he  was 
informedby  the  patient  that  a  physician  in  New 
York  had  been  treating  her  for  some  "  internal 
trouble,"  giving  her  small  pills,  after  which  the 
urine  was  invariably  blue  for  some  time. 

The  urine  was  submitted  to  Dr.  G.  C.  L.  Wolf 
for  analysis,  who  reports  as  follows  : — Fluid  of  a 
bright  bluish  green  color  ;  odor  of  phenol ;  acid 
reaction  ;  specific  gravity  1032  ;  urea,  1.15  p.c. ; 
glucose,  5.87  p.c.  (28.16  grains  per  ounce). 
On  making  an  examination  to  ascertain  the  na- 
ture of  the  coloring  matter,  Dr.  Wolf  found  that 
by  treating  with  strong  HCl.,  the  color  was  to 
a   great   extent   discharged  j  on    treating   with 


chloroform  the  color  was  taken  up  by  the  sol- 
vent; silk  was  unaffected,  but  cotton,  wool,  and 
especially  cork  wood,  were  v/ell  stained.  On 
examination  with  the  spectroscope,  the  urine 
showed  a  broadband  in  the  red  at  70°  on  Zeiss' 
scale,  when  60''  was  placed  in  the  first  oxyhemo- 
globin line.  Solutions  of  various  blue  dyes  with 
urine  were  made  up,  and  with  methylene  blue  a 
band  was  obtained  in  precisely  the  same  position. 
The  urine  showed  no  bands  before  and  after  E., 
which  would  lead  to  a  suspicion  of  Indian  col- 
oring matters.  The  conclusion,  therefore,  was 
that  the  color  of  the  urine  was  due  to  methylene 
blue,  and  the  assumption  followed  tliat  this  was 
the  drug  prescribed  by  her  physician  in  New 
York.  Dr.  Adami  stated  that  Dr.  Wolf  had 
called  attention  to  the  fact,  that,  as  pointed  out 
in  a  recent  number  oi  ih^  Journal  of  the  Soci- 
ety of  Chemical  Industry,  if  glucose  be  heated 
with  methylene  blue,  the  color  disappears.  He 
found  that  upon  keeping  this  blue  urine  in  a 
sealed  tube,  it  became  slowly  decolorized.  This 
may  be  taken  as  an  additional  proof,  if  such 
were  needed  after  the  admirable  proof  already 
given  by  him,  that  the  coloring  matter  in  the 
diabetic   urine  was    methylene  blue. 


Stated  Meeting,  June  1 5///,  1 894. 
James  Bell,  M.D.,  President,  in  the  Chair. 

Carcinoma  of  the  Rectum. — Dr.  Williams 
reported  the  case  for  Dr.  Kirkpatrick.  Mrs.  M., 
aged  39,  admitted  to  the  General  Hospital  on 
May  29th,  For  one  year  she  had  suffered  from 
irregularity  of  the  bowels  and  pain  during  defe- 
cation. For  the  past  two  months  she  had  suffer- 
ed from  persistent  diarrhoea,  otherwise  her  gen- 
eral health  had  been  good.  Examination  re- 
vealed a  stricture  of  the  rectum,  about  2  inches 
above  the  anus,  impassable  to  the  tip  of  the  little 
finger,  felt  smooth  and  hard,  and  did  not  bleed. 
By  vaginal  examination  the  mass  could  be  easily 
detected.  On  June  nth,  the  patient  was  ether- 
ized, and  the  stricture  was  incised  along  the 
posterior  part  with  a  blunt  pointed  bistoury, 
and  dilated.  The  bowel  was  then  irrigated  with 
a  warm  .boracic  solution,  and  a  large  rubber  tube 
wrai)ped  about  with  iodoform  gauze  inserted. 
The  patient  sank  and  died  nine  hours  after  the 
operation. 

Owing  to  the  smooth  fibrous  surface  of  the 
lower  end  of  the  mass,  Dr.  Kirkpatrick  was  at 
first  disposed  to  regard  it  as  a  syphilitic  stric- 
ture. However,  after  a  more  thorough  examina- 
tion under  ether,  especially  noting  the  totally 
difi'erent  character  of  the  upper  portion  of  the 
mass,  he  was  satisfied  of  its  malignant  nature. 

Dr.  Adami  had  found  at  the  autopsy  an  irre- 
gular rent  4  cm.  long  in  the  anterior  wall  of 
the  rectum  through  which  fluid  had  passed  into 
Douglas'    pouch.     The  abdominal    cavity  con- 


THE  CANADA.  MEDICAI-  RECORD. 


lained  24  ounces  of  tiuid  of  a  light  brown  color 
The  lower  portion  of  the  rectum  was  thickened 
and  constricted  for  5-S  cm.  of  its  length,  witli 
the  mucous  surface  rough  and  nodular.  The 
growth  extended  back  towards  the  sacrum,  but 
did  not  involve  the  uterus  or  bladder.  Micro- 
scopic examination  showed  the  growth  to  consist 
of  small  round  cells  and  spindle  cells,  witii  large 
amount  of  connective  tissue,  infiltrating  the  mu- 
cous and  submucous  coats  lying  between  bands 
of  muscle  fibres  and  extending  to  the  peritoneum. 
In  places  there  was  considerable  destiuclion  of 
the  mucoi's  membrane.  The  diagnosis  was  that 
ofschirrus  cancer,  which  is  thoi'ght  to  have 
originated  in  the  submucosa,  and  spread  to  the 
neighboring  tissues. 

Dr.  Jas.  Bell  wished  to  know  if  the  mi- 
croscopic appearances  in  this  case  were  defin- 
itely characteristic  of  carcinoma.  Even  in  case 
they  were,  he  would  be  still  inclined  to  doubt 
its  cancerous  nature  in  the  face  of  the  clinical 
history  and  physical  appearances  of  the  condi- 
tion. A  young  woman,  only  39  years  of  age, 
in  good  health,  with  the  exception  of  a  diarrhoea 
which  does  not  appear  to  have  caused  much 
wasting,  is  not  a  likely  subject  for  cancer.  The 
only  physical  sign  present  was  the  very  marked 
stricture  of  the  rectum,  and  when  this  was  laid 
open  no  tumor  was  found  surrounding  it.  The 
speaker  directed  the  members'  attention  to  the 
bowel  now  before  them,  and  pointed  out  that 
there  was  no  mass  in  it,  neither  had  it  anything 
which  gave  one  the  characteristic  feeling  of  can- 
cerous infiltration.  In  the  presence  of  such 
evidence,  contra-indicating  cancer,  he  thought 
we  were  not  justified  in  making  a  diagnosis  on 
the  microscopical  evidence  alone.  Such  con- 
ditions are  often  the  result  of  syphilis,  and  are 
amongst  the  manifestations  of  that  disease  which 
do  not  yield  to  treatment.  He  had  seen  four 
casesfof  this  kind  within  the  past  year,  two  of 
which  he  operated  upon  by  excising  portions 
of  the  bowel.  In  the  first  case  he  excised  about 
four  inches,  in  the  second  a  little  less,  and  in 
both  he  was  rather  surprised  and  disgusted  upon 
finding  after  excision  how  little  real  infiltration 
or  tumor  there  was.  Before  the  operation, 
upon  examining  the  bowel,  one  got  this  feel- 
ing of  stricture  and  hard  infiltration,  but  after 
its  removal  the  condition  noticed  was  just  like 
what  is  seen  in  this  case — no  real  thickening,  no 
mass  or  neoplasm.  Both  of  his  specimens  had 
been  submitted  to  Dr.  Adami,  who  had  not  been 
able  to  arrive  at  any  satisfactory  conclusion, 
beyond  the  fact  that  the  specimens  were  not 
cancerous  and  showed  evidences  of  some  chro- 
nic inflammatory  change.  A  third  case  died 
in  the  hospital  with  extensive  ulcerations 
throughout  the  intestines.  The  fourth  case  he 
saw  quite  recently,  and  had  the  characteristic 
appearances  of  syphilis  about  the  buttocks  and 
anus.  In  all  these  four  cases,  Dr.  Bell  expres- 
sed himself  as   convinced  that    he  was   dealing 


with  syphilis,  although  at  the  time  in  none  of 
them  had  he  made  that  diagiiosis.  The  two 
cases  which  he  operated  on  last  fall  have  since 
done  well,  which  would  not  be  the  case  had  he 
been  dealing  with  cancer.  His  first  patient  has 
had  a  return  of  the  same  condition  as  well  as 
some  similar  growths  about  the  margin  of  the 
anus  which  have  been  treated  with  caustic,  etc., 
but  he  has  not  lost  flesh,  although  suffering  from 
diarrhoea  with  mucous  stools,- sometimes  slight 
haemorrhages,  and  tenesmus.  The  second  case 
has  had  no  return,  and  is  doing  very  well. 

An;^iomata  of  the  Colon. — Dr.  Williams 
next  presented  a  portion  of  the  descending  colon 
with  microscopicalsections  of  some  angiomatous 
growths  affecting  the  same,  which  v/ere  obtain- 
ed by  Dr.  Aoami  at  a  recent  autopsy. 

Dr.  Adami  found  upon  opening  the  abdomen 
that  the  great  omentum  was  collected  in  a  mass 
beneath  the  left  hypochondrium,  and  was  of  a 
grayish  turbid  appearance.  The  intestines  were 
somewhat  reddened,  and  showed  scattered  over 
the  serous  surface,  especially  upon  that  of  the 
transverse  colon,  numerous  minute  ecchymoses. 
The  descending  colon  was  ofa  deep  bluish  black 
color,  and  had  a  peculiarly  dense  feel. 

On  section  there  was  evidence  of  inflamma- 
tion throughout,  most  marked  in  the  descend- 
ing colon  commencing  at  the  splenic  flexure. 
At  this  point  a  band  of  adhesions  having  form- 
ed, produced  a  second  flexure,  and  below  this 
the  organ  was  contracted,  with  thickened  walls, 
and  of  a  dark  congested  appearance.  In  its  walls 
were  observed  about  a  dozen  brownish  bodies, 
averaging  1.5  cm.  in  diameter,  and  project- 
ing from  the  mucosa,  producing  a  considerable 
constriction  in  the  gut.  On  microscopical  ex- 
amination of  one  of  these  nodules  the  mucous 
membrane  was  found  raised  up;  the  angiomatous 
growth  is  in  the  submucosa,  and  is  of  the  hyper- 
trophic and  capillary  variety  ;  the  muscular  coat 
was  drawn  in  into  the  centre  of  the  nodule,  at 
the  apex  of  which  haemorrhages  frequently  oc- 
curred. The  surrounding  tissue  was  thickened, 
and  contained  a  quantity  of  fat. 

A  Case  of  Infection  by  the  Bacillus  Pyocya- 
neus. — Dr.  Williams  reported  the  following 
case  : 

A  child  five  months  old,  an  inmate  of  the 
Montreal  Foundling  and  Infant  Nursery,  who 
had  previously  been  well,  and  nursed  by  a 
healthy  mother,  began  without  any  apparent 
reason  to  fail. 

For  two  months  he  steadily  lost  weight,  be- 
came restless, and  seemed  to  suffer  from  abdom- 
inal pain.  When  Dr.  Williams  saw  him  he  ap- 
peared listless,  and  moaned  when  the  abdomen 
was  touched.  There  was  a  small  group  of  purple 
papules  on  either  side  of  the  umbilicus.  The 
abdomen  was  relaxed  and  the  skin  dry.  Diar- 
rhoea with  greenish  stools  had  been  present  for 
some  time,and  there  wasa  slightfeverCgp^-roo*^). 

These  papules  increased  in  number,  became 


8 


THE   CANADA   MEDICAL   RECORR 


of  a  deeper  blue  color,  and  spread  to  tlie  ciicst. 
shoulders  and  thighs  ;  the  abdominal  pain 
ceased,  but  the  child  became  worse.  The  limbs 
were  rather  stiff,  flexed  :  the  child  seldom 
moved,  and  cried  when  the  limbs  were  extended, 
while  they  at  once  became  flexed  again.  Dr. 
Kenneth  Cameron  then  took  charge  of  the 
Nur.'ery,  and  noticed  that  during  three  days 
preceding  the  child's  death  h.'emorrhages  oc- 
curred from  the  nose,  from  between  the  toes 
and  from  abraded  papules  on  the  thigh  and  back. 
The  day  before  death  a  slight  discharge  was 
noticed  from  the  right  ear. 

At  the  autopsy  the  organs  were  seen  to  be 
pale.  Minute  petechiae  were  present  in  the 
mucosa  of  the  stomach  and  intestines,  but  no 
haemorrhages  had  occurred  into  these  organs. 
There  were  two  haemorrhagic  infarcts  in  each 
kidney  and  one  on  the  heart. 

Cultures  prepared  on  gelatin  from  the  spleen, 
kidney,  liver  and  blood,  and  kept  at  the  tem- 
perature of  the  room,  gave  in  seven  days  the 
characteristic  growth  of  ihe  baci'lus  pyocya- 
neus. 

Careful  cultivation  sho.ved  this  to  be  a  pure 
growth,  and  after  various  media  had  been  satis- 
factorily tried,  a  rabbit  was  inoculated  with  0.5 
c.c.  of  a  broth  culture. 

The  animal  had  diarrhoea  and  stiffness  of  the 
extremities,  became  comatose,  and  died  in  forty 
hours. 

On  examination,  punctate  hcemorrhages  were 
found  in  the  mucosa  of  the  stomach  and  intes- 
tines, and  the  bacillus  was  found  in  the  various 
organs  and  in  the  intestinal  contents  and  urine. 

Microscopic  sections  of  the  liver,  spleen  and 
kidneys  showed  the  bacillus  in  large  numbers 
in  the  small  blood  vessels  and  about  the  capil- 
laries, causing  numerous  minute  thrombi  and 
commencing  parenchymatous  degeneration. 

The  case  appeared  to  be  of  interest,  as  he 
had  been  able  to  find  but  three  other  cases 
reported  of  primary  infection  by  the  bacillus 
pyocyaneus  alone.  These  were  by  Neumann 
and  Ehlers.  They  all  occurred  in  children,  and 
were  similar  in  nearly  every  respect,  except  in 
the  character  of  the  eruption,  which  from  the 
papular  form  became  bullous  and  pustular,  the 
contents  developing  in  time  a  blue  color. 

There  had  been  a  number  of  cases  where  the 
bacillus  had  been  found  associated  with  other 
micro-organisms,  especially  in  suppurating 
wounds,  erysipelas,  etc.,  and  in  one  instance 
after  enteric  fever.  ]'ut  one  writer  in  English, 
H,  C.  Ernst,  had  mentioned  finding  the  bacil- 
lus. He  records  a  case  where  it  occurred  in  the 
pericardial  fluid,  associated  with  the  tubercle 
l)acillus,  although  from  its  large  size  and  slight 
modifications  in  color  production  he  had  con- 
sidered it  another  variety  of  the  I],  pyocyaneus. 

Dr.  Williams  expressed  his  sincere  thanks  to 
Dr.  Adami  for  his  kind  assistance  in  the  bacte- 
riological work  and  in  investigating  the  litera- 
ture of  the  subject. 


Dr.  Adami  thought  this  was  a  singularly  in- 
teresting case,  as  it  is  the  first  of  the  kind  rejiort- 
ed  in  America.  Several  cases  have  occurred  in 
France,  two  in  Germany,  and  two  in  Copen- 
hagan,  where  the  bacillus  has  been  fouud  patho- 
genic. The  attention  of  pathologists  was  first 
directed  lo  this  organism  by  the  occurrence 
from  lime  to  time  of  a  blue  color  in  the  dressing 
from  supi^urating  wounds,  and  which  was  for- 
merly supposed  to  be  due  to  the  presence  and 
reaction  of  iodine  on  starch  in  the  bandages. 
The  investigations,  however,  of  Gessard  and 
others  proved  this  blue  color  to  be  due  to  the 
growth  of  a  little  bacillus,  which  was  so  short 
as  to  be  sometimes  mistaken  for  a  micrococus. 
The  blue  color,  moreover,  was  found  not  to  be 
due  to  the  bacillus  itself,  but  to  a  secretion  pro- 
duced by  the  bacillus  ;  and  this  blue  pigment 
was  further  shown  to  be  a  combination  of  several 
pigments,  blue,  green,  and  red,  all  of  which  have 
been  isolated  and  given  separate  names,  such 
as  pyocyanine,  pyozanthin,  etc.  Speaking  of 
its  pathognomonic  qualities,  Dr.  Adami  said 
that  in  man  it  is  most  commonly  found  on  the 
surface  of  wounds,  aud  ordinarily  is  not  virulent 
enough  to  cause  death.  As  Dr.  Williams  men- 
tioned, it  is  seldom  a  primary  affection,  and  has 
heretofore  been  chiefly  regarded  as  a  disagreea- 
ble complication  rather  than  as  a  disease  in 
itself.  Some  workers  in  this  field,  however, 
having  obtained  pure  cultures  of  the  bacillus, 
inoculated  rabbits  with  them,  and  studied  the 
effects.  After  large  doses  the  animal  suffers  from 
severe  diarrhoea  and  hasmaturia,  grows  gradu- 
ally comatose,  and  dies  within  from  24  to  40 
hours.  Autopsies  reveal  haemorrhages  through- 
out the  various  organs  of  the  body.  When 
smaller  doses  are  given,  the  animal  emaciates, 
has  a  diarrhoea,  and  dies  from  a  kind  of  ascend- 
ing paralysis.  It  is  only  the  young  and  very 
feeble  of  the  human  family  that  seem  to  be  sus- 
ceptible to  general  infection  from  this  microbe, 
such  as  occurs  in  the  rabbit  :  and  it  is  of  inter- 
est to  observe  that  when  a  case  does  occur  a 
parallelism  between  the  symptoms  in  the  two 
animals  exists.  There  is  the  same  diarrhoea,  the 
same  weakness  or  prostration,  and  the  same 
haemorrhages  both  mucous  and  cutaneous.  It  is 
quite  possible  that  such  cases  are  more  common 
among  children  than  is  generally  supposed. 

Dr.  Kenneth  Cameron  thought  that  the 
cutaneous  haemorrhages  which  occurred  between 
the  toes  were  of  interest,  as  there  had  been 
absolutely  no  injury  to  account  for  their  appear- 
ance ;  they  seemed  to  be  simj^le  extravasations 
of  blood.  He  regretted  very  much  that  neither 
the  blood  nor  the  urine  had  been  examined  dur- 
ing life.  .\  case  with  an  almost  exactly  similar 
eruption  occurred  in  the  nursery  about  a  year 
ago,  which  proved  fatal,  but  the  autopsy  showed 
no  h.-cmorrhages  of  the  internal  organs.  No 
bacteriological  examination  had  been  made. 

Dr.  Reed  asked  if  there  was  any  theory  as  to 


THE  CANADA  MEDICAL  RECORD. 


how  the  bacillus  had  obtained  an  entry  into  the 
body. 

Dr,  Williams,  in  reply  lo  Dr.  Reed's  ques- 
tion, thought  that  aside  from  the  infection 
through  a  wound,  the  alimentary  tract  might 
be  the  most  likely  point  of  entrance,  and  men- 
tioned a  case  reported  by  Oettinger  wliere  a 
young  man,  i8  years  of  age,  convalescent  from 
typhoid,  suddenly  developed  a  fever,  witli 
some  other  symptoms  unlike  those  of  the  pre- 
vious ilness,  and  on  examining  tiie  stools  this 
bacillus  was  discovered.     He  recovered. 

Mycetoma  Pedis  —  Madura  Foot  Disease. 
Dr.  Williams  read  for  Dr.  Kirkpatrick  the 
following  report,  and  exhibited  the  specimen  : 

Xavier  Lecompte,  st  21,  a  French-Canadian, 
was  born  in  Montreal,  and  has  always  lived 
here  with  the  exception  of  five  years  which  he 
passed  in  Ontario  between  the  age  of  twelve  and 
seventeen. 

His  parents,  three  brothers  and  four  sisters, 
are  living  and  in  fair  healtn.  No  history  of 
tuberculosis  can  be  obtained. 

At  the  age  of  eleven,  a  bluish  spot  appeared 
on  the  inner  side  of  the  foot,  which  gradually 
increased  until  it  became  the  size  of  a  five  cent 
piece.  One  day  while  walking  he  struck  the 
foot,  breaking  open  the  spot,  from  which  a  little 
blood  escaped.  After  this  the  spot  disap- 
peared. 

A  few  months  later,  what  he  described  as  a 
button  of  flesh  (un  bouton  de  chair)  appeared 
on  the  sole  of  the  foot  between  the  first  and 
second  metatarsals,  which  was  later  on  removed, 
leaving  a  little  hole  which  ultimately  healed. 
Three  years  later  a  similar  growth  appeared  on 
the  dorsum  of  the  foot  directly  opposite  to  where 
the  other  nodule  had  been  on  the  sole.  Two 
years  after  he  struck  the  foot  with  an  axe,  bruis- 
ing it  severely,  and  ever  since  the  foot  has  re- 
mained swollen  and  tender,  though  he  was  quite 
able  to  walk  until  last  fall,  when  the  condition 
became  very  much  aggravated,  the  nodules  ap- 
pearing all  over  the  foot. 

The  discharge  from  the  sinuses  has  always 
been  scanty  and  of  a  thin,  purulent  character. 
He  came  to  the  General  Hospital,  where,  as  the 
foot  seemed  useless,  it  was  amputated. 

Dr.  Adami  remarked  that  in  the  pressure  of 
work  he  had  delayed  the  examination  of  the 
foot  until  that  afternoon  when  first  he  heard  that 
it  was  to  be  brought  before  the  Society  that 
evening. 

On  proceeding  to  examine  it,  he  was  imme- 
diately struck  by  the  resemblance  between  the 
general  appearance  of  the  amputated  foot  and 
that  of  cases  of  madura  foot.  There  were  the 
same  button-like  elevations  of  the  skin  scattered 
over  the  surface,  and  at  their  centres  the  same 
fine  sinuses  leading  deep  down  into  the  interior 
of  the  foot,  while  by  pressure  upon  the  buttons 
there  was  expelled   a  thin  pus  containing  cha- 


racteristic yellowish  gray  bodies.  Upon  study- 
ing the  discharge  under  the  microscope,  and 
again  upon  examination  of  sections,  the  struc- 
ture of  these  bodies  could  be  clearly  made  out. 
They  clearly  lesembled  in  general  appearance 
the  ray  fungi  of  actinomycosis,  forming  lobate 
masses  of  varying  size,  the  larger  being  easily 
distinguished  by  the  naked  eye,  some  indeed 
being  as  big  as  small  shot.  Like  actinomyces, 
the  masses  showed  a  radiate  arrangement  of 
filaments  or  clubs  all  around  the  periphery,  with 
a  central  irregular  network  of  filaments  ;  unlike 
actinomyces,  the  clubs  were  so  large  that  they 
could  be  recognized  by  the  low  power  of  the 
miscroscope  (Zeiss  A),  and  under  the  high 
power  there  was  a  marked  tendency  observed 
for  the  clubs  to  bifurcate.  In  the  secHons  the 
masses  could  be  seen  surrounded  by  collections 
of  leucocytes,  so  loose  that  unless  special  precau- 
tions were  taken,  the  fungi  fell  out.  These  ap- 
pearances tally  entirely  with  the  very  full  des- 
cription given  by  Kanthack  in  \.\\q  Journal  0/ 
Pathology,  Vol.  I.  Whether  this  is  a  species 
absolutely  identical  with  the  Indian  form  can 
only  be  determined  by  comparison  of  material. 
The  clinical  history, and  the  hurried  examination 
so  far  made,  point  on  the  whole  to  this  being  a 
case  of  true  madura  foot,  and  to  the  species  asso- 
ciated with  the  disease  being  one  and  the  same. 
Dr.  Adami  pointed  out  that  as  in  the  previous 
case  so  here  he  had  brought  before  the  vSociety 
what,  to  the  best  of  his  belief,  was  rhe  first  case 
of  the  kind  reported  in  any  English-speaking 
country. 

The  disease  of  "  madura  foot "  occurs  with  fair 
frequency  in  certain  parts  of  Hindustan,  but 
outside  of  India  is  very  rare.  A  case  had,  he 
thought,  been  reported  in  Italy,  another  more 
recently  in  Algiers,  where  Vincent  had  been 
able  to  gain  a  pure  culture  of  the  fungus,  ano- 
ther in  Germany.  The  characteristics  of  the 
disease,  which  has  been  recognized  for  the  last 
thirty  years,  are  its  chronic  nature,  its  limitation 
to  the  lower  extremities  and  the  development 
of  numerous  sinuses.  More  recently  attention 
has  been  called  by  Van  Dyke  Carter  and  others 
to  the  constant  presence  of  peculiar  bodies  in  the 
discharge.  These  are  either  black  or  yellow, 
and,  as  already  indicated,  Kanthack  has  conclu- 
sively shown  them  to  be  closely  allied  in  struc- 
ture to  the  actinomycosis  fungus.  The  disease 
would  seem  to  be  most  common  in  countries 
where  the  inhabitants  go  about  barefoot ;  it  was 
noticeable  that  though  in  Canada  it  is  not  the 
habit  to  do  so,  the  disease  in  this  case  was  con- 
tracted during  childhood,  that  is  to  say,  during 
the  period  of  frequent  barefootedness. 

Dr.  Gordon  Campbell  pointed  out  that  in 
Crocker's  work  on  the  Diseases  of  the  Skin, there 
was  a  reference  to  a  previous  case  of  madura 
foot  reported  from  America.  He  did  not  think 
that  any  details  were  given. 


lO 


THE   CANADA   MEDICAL   RECORD. 


MEDICAL  AND  CHIRURGICAL  STATE 
FACULTY  OF  MARYLAND- 

Dr.  Walter  }i.  Flatt  read  a  iia|)cr  on  a 
case  of  laminectomy,  the  operation  having  been 
performed  eleven  months  after  injury  to  the 
spine.  The  patient  liad  sHpped  on  the  stairs, 
and  two  weeks  later  fell  from  a  car.  In  an- 
other week  he  was  confined  to  bed,  suffering 
from  great  pain  in  the  back.  There  was  a 
curvature  of  the  spine  at  the  painful  point,  and 
below  it  complete  paraplegia  and  loss  of 
sensation.  Bed-sores  also  appeared.  Two 
parallel  incisions  were  made  to  the  inner  side 
of  the  transverse  processes,  and  joined  by  a 
transverse  incision,  forming  the  shape  of  an  H. 
Haemorrhage  was  controlled  by  means  of 
pressure,  and  the  lamince  of  the  fifth,  sixth  and 
seventh  vertebrre  removed.  The  flap  was 
turned  down,  the  dura  examined  and  found 
healthy,  and  the  flap  replaced  without  tying 
any  arteries.  The  operation  required  one 
hour  and  twenty  minutes.  Venous  hemorr- 
hage was  considerable.  Two  weeks  later,  at 
the  lime  of  report,  the  patient  was  able  lo  lie 
on  either  side  without  fatigue,  had  no  more 
night-sweats,  but  there  was  no  improvement  in 
sensation.  The  author  favors  the  operation  in 
perfectly  hopeless  cases.  The  prognosis  de- 
pends upon  the  site  of  the  injury  ;  the  nearer 
the  head,  the  less  the  chances  of  success.  If 
the  body  of  the  vertebra  is  fractured,  there  is 
little  hope  of  success. 

Dr.  T.  A.  AsHBV  read  a  paper  on  sterility 
due  to  tubal  and  ovarian  disease,  which  was 
discussed  at  some  length.  Dr.  J.  E.  Michael 
regarded  the  paper  as  valuable,  emphasizing 
as  it  did  the  growing  tendency  to  save  rather 
than  to  destroy  the  generative  organs  in 
woman.  He  believed  that  ovulation  was  due 
to  a  current  set  up  in  the  ciliated  epithelium 
of  the  tube,  and  that  disease  of  the  tube  pre- 
vented this  action.  Ovulation  and  menstrua- 
tion were  not  synchronous,  since  conception 
often  takes  place  before  menstruation  is  estab- 
lished. 

Dr.  Cha.s.  p.  Noble,  of  Philadelphia,  be- 
lieved ovulation  to  depend  much,  more  on  the 
tube^  and  ovaries  than  on  the  vagina  and 
uterus.  An  ovary  that  is  partly  diseased  may 
be  saved,  but  there  is  little  hope  that  diseased 
tubes  will  ever  amount  to  anything. 

Dr.  H.  A.  Kellv  said  that  it  was  important 
for  the  general  jjractitioner  to  know  how  to 
deal  with  a  case  of  sterility.  No  woman  should 
be  pronounced  sterile  until  her  husband  has 
been  examined.  Imi>ermeability  of  the  os  uteri 
is  sometimes  the  cause,  and  here  simple  dilata- 
tion will  effect  a  cure. 

Dr.  Kellv  rQ\>o\\c<\  thirty-nine  casts  of  rc- 
vioval  of  the  uterus,  some  by  the  vagina  and 
some  by  the  abdomen.  There  was  one  death, 
not  due  to  the  operation,    but  to  sejitic  catgut. 


He  had  used  the  clamp  method  in  the  first  cases, 
drawing  out  the  tumor,  adjusting  the  clamp, 
and  leaving  it  there  until  the  wound  had  healed. 
Ry  the  combined  extra-and  intra-peritoneal 
methods,  the  abdomen  was  oi)ened,  tumor  lifted 
out,  vessels  tied,  stump -cauterized  to  prevent 
sepsis,  and  fastened  to  the  lower  angle  of 
wound.  The  method  he  at  present  uses  is  to 
make  an  incision  and  put  on  ligatures  to  pre- 
vent hoimorrhage  while  operating.  Only  four 
large  arterial  trunks  feed  the  tumor,  and  two  of 
these  are  reached  at  once.  The  broad  ligament 
is  drawn  aside  with  the  fingers.  Great  care  is 
taken  not  t6  allow  the  contents  of  the  uterus 
and  cervix  to  touch  the  stump,  which  is  always 
disinfected  with  the  cautery  or  cut  off  and  left 
cup-shaped.  A  few  silk  ligatures  are  put  in  the 
stump,  the  abdomen  cleaned  out  (though  it 
should  never  be  allowed  to  be  anything  but 
clean),  oozing  of  small  veins  stopped,  ligatures 
cut  off  and  stump  replaced  in  abdomen,  the 
pedicle  being  turned  upside  down  so  that  the 
bladder  is  exposed  to  view. —  Universal  Medi- 
cal fournal. 

COLLECzE  OF  PHYSICIANS  OF  PHILA- 
DELPHIA. 

Dr.  J.  B.  Deaver  presented  a  patient  upon 
whom  he  had  performed  subcutaneous  osteotomy 
of  the  neck  of  the  metatarsal  bone  for  hallux 
valgus.  He  detailed  the  history  of  the  case, 
which  resulted  from  frost-bite,  but  in  which, 
as  in  many  of  these  cases,  there  may  have  been 
a  rheumatic  tendency.  The  author  expressed 
his  belief  in  the  superiority  of  the  operation 
over  amputation  in  such  cases,  and  stated  that 
it  was  attended  by  no  risk,  and  that  a  good 
result  might  be  promised  the  patient. 

Dr.  H.  Augustus  Wilson  exhibited  a  cast 
of  a  similar  case,  in  which  there  was  extreme 
hallux  valgus  of  the  right  foot,  the  metatarsal 
bone  being  pushed  from  the  normal  position 
under  the  second  biceps.  A  bursa  on  the 
right  foot  was  opened,  under  the  impression 
that  it  was  a  corn  or  bunion,  when  it  was 
found  to  be  a  segment  of  the  joint.  The  pain 
was  intense. 

Dr.  T.  G.  Morton  presented  an  unusual  case 
oi general  bodily  deformity  with  ankylosis  of 
the  spine,  upper  and  lower  extremities,  etc. 
The  patient  was  32  years  old,  and  was  well 
until  tlie  age  of  10  years,  when  rheumatism 
appeared  in  the  right  hip-joint,  spreading 
grailually  to  the  knee-joint  of  the  same  limb, 
the  ankle,  the  joints  of  tiie  left  lower  extremity, 
spinal  column,  both  shoulders,  elbows,  wrists, 
fingers  and  toes.  This  process  required  three 
years,  during  which  time  his  suffering  was 
intense.  Tlie  lateral  curvature,  elevation  of 
shoulders,  curve  of  femora,  and  other  deformi- 
ties were  due  to  his  position  in  a  chair,  which 
he  occupied  most  of  the   time,  being  unable  to 


THE   CANADA   MEDICAL   RECORD. 


I  I 


move  about.  His  present  state  is  as  follows  : 
Head  normal  'in  sha]:)e  and  size;  wears  a  7^8 
hat ;  trunk  undersized  and  misshaped  ;  antero- 
posterior and  lateral  curvature  of  the  spine, 
which  is  perfectly  rigid  ;  legs  flexed  on  thighs, 
almost  in  contact;  thighs  on  jjelvis  and  in 
contact  with  the  abdomen  ;  and  pelvis  upon 
the  thorax,  the  anterior  superior  spinous  pro- 
cesses of  the  ilia  being  almost  in  contact  with 
the  lower  ribs ;  all  the  joints  ot  the  lower 
extremities  are  firmly  ankylosed,  with  the 
exception  of  the  phalanges.  The  right  arm  can 
be  bent  at  an  angle  of  forty-five  degrees  with 
the  shoulder.  The  left  elbow  is  fairly  ankylosed 
no  pronation  or  supination.  The  left  arm  can 
be  brought  to  a  right  angle  with  the  trunk  at 
the  shoulder  :  left  elbow  firmly  ankylosed  at  a 
right  angle  ;  pronation  and  supination  normal ; 
wrist  and  phalangeal  joints  normal.  Weight 
523  pounds;  height  from  top  of  head  to  low- 
est part  of  body  as  he  sits  in  chair,  22  inches  ; 
right  calf  5^8  inches  ;  right  arm,  5f  inches  ; 
left  arm,  4f  inches  ;  right  forearm,  6  inches  ;  left 
forearm,  4f  inches ;  appetite  fair  :  digestion 
good,  tendency  to  constipation ;  heart,  liver 
and  lungs  normal ;  urine  highly  acid;  specific 
gravity,  1030  excess  of  urates;  no  abnormal 
constituents. 

Dr.  Morton  felt  that  in  this  case  there  was 
little  to  be  hoped  for  by  operation,  and  that 
the  best  that  could  be  done  was  to  furnish  the 
patient  with  a  suitable  brace  to  support  the 
arms  as  an  attachment  to  a  proper  spinal  brace. 
Dr.  H.  A.  Wilson  thought  a  wheel-chair 
would  be  best  for  him.  Dr.  G.  G.  Davis 
advocated  an  operation  to  enable  the  man  to 
stand  upright,  seeing  that  he  was  in  a  moder- 
ately healthy  condition,  and  would  likely  stand 
the  operation  well.  Drs.  Wharton,  DeForest, 
WiLLARD  and  J.  B.  Deaver  agreed  with  Dr. 
Morton  that  operation  was  not  advisable. — 
Universal  Medical  Joiirnal. 


Iro^rcss    of    Science. 


APPENDICITIS. 

Just  at  present  the  interest  in  both  medical 
and  surgical  circles  seems  to  center  chiefly 
about  the  appendix  vermiformis,  that  curious 
little  structure  which  the  Darwinists  would 
have  us  beheve  is  only  useful  to  the  human 
race  as  a  reminder  of  its  humble  origin,  having 
long  since  lost  the  useful  office  which  it  is  said 
to  have  once  served  as  a  digestive  organ  when 
man  was  only  an  anthropoid  mammal,  and  sub- 
sisted upon  the  coarse  and  undifferentiated 
products  of  the  primeval  forests.  Whether  or 
not  the  Darwinists  are  right  in  their  theories 
relating  to  the  origin  of  this  troublesome  little 
pouch,  is  a  question    we  shall   not   just  now 


undertake  to  discuss.  The  burning  question 
of  the  day  is  :  Under  what  circumstances  we 
are  to  consider  that  tolerance  of  the  mijchief- 
making  appendix  has  ceased  to  be  a  virtue. 
Upon  this  subject  all  possible  shades  of  opinion 
arc  expressed,  together  with  an  almost  infinite 
variety  of  theories  respecting  the  etiological 
factors  which  are  active  in  developing  the  in- 
herent mischief-making  propensities  of  this 
functionless  diverticulum. 

A  New  York  surgeon  advances  the  theory 
that  it  is  the  duty  of  every  surgeon  to  exercise 
himself  to  the  extent  of  his  ability  in  the  in- 
terest of  the  evolution  of  an  appendix-less  race 
of  human  beings,  which  means,  of  course,  war 
to  the  knife  against  the  unruly  member  until 
the  last  member  of  the  human  family  shall  have 
undergone  what  might  be  termed  a  sort  of 
biological  circumcision,  and  have  been  thereby 
elevated  to  the  high  estate  of  completely  evo- 
luted  manhood. 

Really,  it  seems  to  us  that  this  is  carrying 
things  a  little  too  far.  Even  if  the  surgeon  be 
so  skillful  as  to  be  able  to  perform  the  opera- 
tion upon  a  subject  through  an  inch  and  a  half 
incision,  and  to  get  him  out  of  bed  in  a  week 
and  a  half,  a  la  Dr.  Morris,  it  must  be  admitted 
that  the  subjection  of  the  whole  human  family 
to  this  operation  would  result  in  more  deaths 
than  ever  have  been  caused  by  captured 
cherry  pits  or  apple  seeds. 

Asepsis  is  a  procedure,  the  value  of  which 
cannot  be  overestimated  ;  nevertheless,  the  com- 
parative immunity  from  fatal  consequences 
which  it  secures  for  nearly  all  surgical  proce- 
dures involves  an  evil  of  no  small  proportion, 
the  nature  of  which  scarcely  needs  to  be  even 
hinted  at,  so  notoriously  common  is  the  rash- 
ness, one  might  almost  say  criminal  reckless- 
ness, manifested  by  many  young  surgeons, 
especially  those  whose  educational  opportuni- 
ties have  been  limited,  as  shown  in  the  under- 
taking of  unnecessary  operations  or  operative 
measures,  for  which  neither  the  patient  nor  the 
operator  has  been  properly  prepared.  Com- 
mon sense  and  sound  judgment  are  quite  as 
necessary  as  asepsis  for  scientific  surgery.  The 
sharper  the  tool,  the  more  skilled  must  be  the 
workman. 

Another  matter  worth  considering  is  the  fact 
of  our  ignorance  in  relation  to  the  functions  of 
the  appendix  vermiformis.  The  simple  fact 
that  we  do  not  know  the  use  of  this  organ  is 
not  sufficient  evidence  that  it  is  useless.  Only 
a  few  years  back  we  were  in  the  same  position 
in  relation  to  the  supra-renal  capsules,  the 
thyroid  gland,  the  spleen,  and  other  structures 
which  recent  researches  have  shown  us  to  be  of 
great  functional  importance  to  the  vital  econ- 
omy. If  the  supra-renal  capsules  were  as  easy 
of  access  as  the  appendix  vermiformis,  or  the 
thyroid  gland  as  readily  removable,  it  is  quite 
probable  that  before  this  time  some  thousands 


12 


THE   CANADA   MEDICAL   RECORD. 


of  people  would  have  bccii  uei-rived  ol'  ihtse 
important  blood-purifying  glands.  Without 
having  any  particular  theory  lo  advance,  we 
feel  strongly  inclined  to  the  opinion  that  the 
great  amount  of  attention  now  being  given  to 
the  appendix  verniiformis  will,  in  the  near 
future,  develop  the  fact  that  this  apparently  use- 
less organ  is  not  merely  a  vestige  which  has 
been  handed  down  by  heredity  from  some  by- 
gone age,  when  man  lived  neighbor  lo  the  me- 
gatherium and  required  a  third  stomach  for  the 
satisfactory  performance  of  his  digestive  pro- 
cesses. Nature  is  a  great  economist,  and 
quickly  eliminates  from  her  domain  idle  and 
useless  organs,  as  well  as  useless  and  idle  or- 
ganisms. The  appendix  verniiformis  has  been  | 
studied  alto<iether  from  the  negative  side.  It 
would  be  well,  before  we  decide  to  wage  an 
exterminating  war  against  this  little  organ,  to 
study  this  question  from  the  positive  side. 
Possibly  the  organ  may  be  found  to  be  worth 
preserving  after  all,  when  in  health,  and  worthy 
of  having  a  chance  for  its  life  when  it  gives 
evidence  of  disease. 

The  idea  that  the  abdomen  should  be  opened 
and  the  appendix  removed  upon  the  slightest 
indication  of  inflammatory  disease  in  this  re- 
gion is  about  as  sensible  a  notion  as  that  the 
same  procedure  should  be  adopted  under  simi- 
lar circumstances  in  relation  to  the  ovaries  or 
f'allopian  lubes.  An  inflamed  tube  may  re- 
sult in  suppuration,  pyosalpinx,  general  peri- 
tonitis, and  death.  Probably  more  women 
have  died  from  this  cause  than  men  from  appen- 
dicitis. One  attack  of  ovaritis  or  salpingitis  is 
very  likely  indeed  to  be  followed  by  another 
attack.  The  constantly  recurring  stimulus  of 
the  catamenia  is  an  exciting  cause  of  relapse 
which  is  absent  in  appendicitis.  The  frequent 
recurrence  of  ovaritis  or  salpingitis  is  a  proper 
indication  for  operation.  A  su])purative  in- 
flammation of  an  ovary  or  tube  is  certainly  a 
justifiable  indication  for  operative  interference. 
The  same  must  be  said  of  appendicitis.  It  may 
be  indeed  that  the  suppurative  inflammation  of 
appendicitis  involves  more  hazard  than  a  simi- 
lar condition  of  the  tubes  or  ovaries,  although 
it  can  hardly  be  said  that  the  evidence  is  ])0.si- 
tive  and  clear  upon  this  point.  The  question 
is  bne  in  which  there  is  a  good  chance  for  ex- 
treme views  upon  lioih  sides,  and  hence  it  may 
be  reasonably  expected  that  salutary  results 
will  follow  the  very  general  discussion  of  this 
question  which  is  now  taking  place,  and  that 
in  the  near  future  we  shall  be  possessed  of  such 
facts  and  rules  as  regards  indication  as  will 
guide  the  practitioner  to  a  correct  procedure  in 
any  given  case,  and  will  clearly  define  the  res- 
pective duties  of  the  physician  and  the  surgeon 
in  these  cases. 

— Edit.  Moaci  n  Mcilicinc, 


ErioLOc;v   oi-   cancer. 

Mr.  S.  G.  Shattock,  F.R.C.S.,  Curator  of 
the  Museum  of  St.  Thomas'  Hospital,  in  his 
Morton  Lecture  before  the  Royal  College  of 
Surgeons  of  England,  gives  the  results  of  recent 
experimental  work  by  hijiiself  and  others,  in  the 
investigation  ofdiis  subject.  If  cancer  was 
a  micro-parasitic  disease,  it  should  be  capable 
of  experimental  transmission.  Mr.  Ballance  and 
the  lecturer  had  carried  out  a  series  of  experi- 
ments, in  which  they  had  inserted  portions  of 
freshly  removed  carcinoma  of  the  breast  into 
the  abdominal  cavity,  the  subcutaneous  tissue, 
the  muscles  and  the  anterior  chamber  of  the 
eye  of  various  animals.  The  result  was  in  all 
cases  negative;  the  portions  so  inserted  under- 
went coagulation,  necrosis,  and  were  either 
absorbed  or  became  encapsuled.  At  the  present 
time  there  was  no  authentic  case  on  record,  in 
which  human  carcinoma  had  been  transferred 
to  any  of  the  lower  animals.  Success,  however, 
had  followed  in  certain  cases,  when  the  trans- 
plantations had  been  made  from  one  animal  to 
another  of  the  same  species.  And  in  this  the 
results  followed  the  laws  of  grafting  rather  than 
those  of  ordinary  infection,  for  they  showed  that 
a  portion  of  a  growing  carcinoma,  if  so  trans- 
ferred, would  grow  in  a  second  individual  as  it 
would  have  done  in  the  first ;  but  they  did  not 
really  show  that  carcinoma  was  infective.  Al- 
though there  were  such  strong  clinical  reasons 
for  regarding  cancer  to  be  an  infective  disease, 
it  was  only  lately  that  methods  had  been  devised 
ofcultivatinga  contagium  vivum.  Mr.  Ballance 
and  he  had  made  a  long  series  of  experiments 
in  this  direction,  and  with  a  negative  result.  Up 
to  the  present  time  no  specific  microphyte — 
bacterium,  micrococcus  or  other — had  been 
cultivated  from  carcinomatous  tumors.  Speak- 
ing generally,  the  pathogenic  action  of  bacteria 
arose  from  the  specific  albumoses  and  alkaloids 
which  they  elaborated  ;  but  neither  albumoses 
nor  alkaloids  could  be  extracted  from  carcin- 
oma by  the  most  exhaustive  and  careful 
analyses. 

The  only  positive  results  were  obtained  in 
experimenting  on  the  line  of  Koch's  second 
postulate^  namely,  the  cultivation  of  a  micro- 
organism alleged  to  be  in  the  tissues.  In 
sterilized  sand  and  specially  distilled  water  in 
Petri  capsules,  pieces  of  the  growing  edge  of 
mammary  carcinomata  were  placed,  and  in  no 
fewer  than  six  such  capsules,  of  which  five  were 
infected  from  different  tumors,  they  had 
obtained  actively  moving  amcebre.  In  check 
experiments,  made  with  broth  or  blood  i)lasma, 
no  similar  results  were  had.-  One  of  the  tumors 
used  was  a  sarcoma,  and  it  was  not  a  little 
curious  that  the  same  micro/oon  occurred  in 
carcinoma  and  sarcoma;  it  was  evident,  also, 
from  the  great  numbers  found,  that  a  process 
of    multiplication    was   concerned.     That    the 


THE  CANADA   IMEDICAL   RECORD. 


13 


bodies  in  question  were  not  surviving  leucocytes 
was  proved  by  their  living  in  water,  the  action 
of  which  was  lethal  in  the  case  of  the  mam 
malian  corpuscle,  and  what  completely  dis- 
proved this  possibility  was  that  there  were  othei 
phases  met  with  in  the  sand  of  the  capsules, — 
encapsulation  and  sporulation. — British  Medi- 
cal Journal. 

LAPAROTOMY   IN  TUBERCULOUS 
PERITONITIS. 

O.  V.  Lassens  of  Randers,  Denmark,  per" 
formed  laparotomy  in  the  case  of  a  woman' 
-•-aged  65,  suffering  from  ascites.  The  periton- 
eum was  only  opened  for  one  inch,  eighteen 
litres  (quarts)  of  a  greenish  fluid  being  re- 
moved. The  whole  surface  of  the  peritoneum 
was  covered  with  tubercles,  which  on  micro- 
scopical examination  proved  to  be  of  a  true 
tubercular  nature.  Five  weeks  after  the  op- 
eration the  abdomen  was  normal  and  had 
remained  so  for  nine  months,  when  the  patient 
was  last  observed. — Hospitals-Tidende,  No. 
23,  1893. 

THE  PARASITES    OF  CANCER. 

Kurloff  has  found  what  appears  to  be  the 
organism  {^Rhopaloccphaiiis  canceromatosus) 
described  by  Korotneff,  in  a  primary  cancer  of 
the  dorsum  of  the  hand  in  a  male,  aged  80 
years.  The  supposed  parasite  lay  in  a  vacuole 
within  the  epithelial  cell.  The  tissue  was  ])re- 
pared  as  follows  :  small  pieces  were  fixed  in 
Flemming's  solution  and  cut  in  paraffin. 
Sections  were  stained  in  various  ways,  those 
treated  by  safranin  being  the  most  successful. 
The  most  notable  feature  of  this  parasite  is  its 
great  size  ;  it  is  readily  seen  under  a  magnifica- 
tion of  300  to  400.  It  presents  well  marked 
pseudopodia,  by  which  movement,  with  passage 
from  cell  to  cell,  appears  to  take  place,  Kurloff 
is  satisfied  of  the  parasitic  nature  of  this  body. 
Establishing  itself  within  the  epithelial  cell  of 
the  carcinoma,  it  leads  to  hypertrophy  of  this 
cell,  which  results  in  the  formation  of  epithelial 
"  nests." — Ccntralbl.  f.  Bakt.,  B.  xv,  10  and  11. 

LESIONS  OF  THE  STOMACH  SIMULAT- 
ING CANCER. 

In  Paris  lately,  M.  Ferrier  drew  the  attention 
of  his  colleagues  of  the  Surgical  Society  to  a 
form  of  gastric  disorder  simulating  cancer,  and 
which  was  much  ignored  in  a  surgical  point  of 
view  in  France.  A  woman  entered  the  hospital 
with  gastric  troubles,  presenting  all  the  symp- 
toms of  cancer  and  coinciding  with  the  existence 
of  an  epigastric  tumor.  M.  Ferrier  performed 
laparotomy  for  exploring  purposes,  and  found 
the  stomach  adherent  to  the  walls  of  the  abdo- 
men and  to  the  left  lobe  of  the  liver.  After 
breaking  down  those  adhesions,  the  operator 


closed  the  wound,  and  the  patient  gradually  lost 
all  bad  symptoms,  and  left  the  hospital  quite 
recovered.  In  concluding,  M.  P'errier  said  that 
in  many  cases  purely  inflammatory  lesions 
could  simulate  cancer,  and  an  exploring  opera- 
tion would  put  the  case  in  its  true  light  and  do 
no  harm  to  the  patient. — Med.  Press  and  Circu- 
lar. 


ELECTRICITY 


FOR 
CER. 


PAIN      OF    CAN- 


At  the  New  York  Academy  of  Medicine,  Ur. 
A.  D.  Rockwell  said  that  the  treatment  of  in- 
curable cancer  must  be  very  incomplete  without 
electricity.  Some  would  remember  a  biief 
paper  which  he  had  recently  read  before  the 
Society,  describing  a  case  in  which  strong 
currents  through  large  electrodes  alo  ie  had 
controlled  the  pain  of  cancer  of  the  kidney. 
In  this  case  it  required  more  than  loo  milliam- 
peres,  running  up  even  to  175,  to  relieve  the 
pain.  Large  clay  electrodes  were  used.  He 
thought  the  relief  was  chemical  and  mechanical, 
that  the  vaso  motor  nerves  were  influenced, 
hastening  circulation,  and  thereby  relief  of 
pressure  upon  nerves  of  sensation. 

GENERAL  TREATMENT  OF  CANCER, 

Before  the  same  Society  Dr.  A.  H.  Smith 
recommended  the  preparation  composed  of 
sweet  almond  oil  charged  with  ozone  for  over- 
coming the  fetor  of  cancer ;  also  cannabis 
indica  for  the  relief  of  pain,  which  was  free  from 
most  of  the  objections  pertaining  to  opium.  Dr. 
Collyer  urged  the  total  removal  of  the  disease 
if  possible,  and  the  use  of  the  knife  for  control 
of  hemorrhage  in  uterine  cancer  under  certain 
conditions.  Ch.ian  turpentine  was  apt  to  be 
impure.  The  actual  cautery  would  check 
hemorrhage  and  prolong  life.  The  use  of 
codeine  he  thought  less  likely  to  lead  to  a  drug 
habit  than  that  of  morphine. — N.Y.  Med.Rec. 

THE  EARLY  DIAGNOSIS  OF  UTERINE 
CANCER. 

Dr.  Ernest  Herman,  in  an  address  before  the 
S.  E.  Branch  of  the  British  Medical  Association, 
lays  stress  upon  the  importance  of  an  early 
diagnosis  of  cancer  of  the  cervix  uteri,  for  the 
reason  that  secondary  growths  occur  later  and 
less  often  with  cancer  of  the  uterus  than  with 
that  of  any  other  part  of  the  body,  and,  if  it  is 
removed,  there  is  a  better  prospect  of  freedom 
from  recurrence  than  in  any  other  form  of  the 
disease.  This  disease  occurs  chiefly  toward  the 
end  of  the  child-bearing  period,  but  it  has  been 
seen  in  childhood  and  in  extreme  old  age,  and 
therefore  the  patient's  age  should  not  influence 
the  diagnosis.  A  tendency  to  cancer  is  some- 
times hereditary,  but  this  should  not  have  the 
slightest  weight,  as  only  a  very  small  propor- 
tion of  patients  inherit  the  disease. 


u 


THE  CANADA  MEDICAL  RECORD. 


The  first  symptoms  of  cancer  are  usually 
hemorrhage  and  leucorrhoea  ;  pain  and  wasting 
come  later.  The  early  diagnosis  is  so  important, 
says  Dr.  Herman,  that  any  unusual  hemorrhage 
or  discharge  in  a  woman  who  has  had  children 
is  a  reason  for  vaginal  examinations,  for  it  may 
be  the  first  symptom  of  cancer,  and  the  nature 
of  this  disease  cannot  be  determined  without 
local  examination.  In  considering  the  local 
signs,  the  features  which  distinguish  cancer  in 
any  part  of  the  body  must  be  taken  into  con- 
sideration. 

When  cancer  begins  as  an  outgrowth  from 
the  surface,  it  may  look  like  a  growth  of  warts 
or  papillce,  or  granulations  on  the  vaginal 
portion,  and  the  surface  feels  uneven  or  even 
rough.  It  can  be  detected  by  an  angry,  livid 
red  spot,  the  surface  of  which  is  at  first  quite 
smooth.  This  angry  color  depends  upon  the 
vascularity  caused  by  the  new  growth  and  upon 
its  tendency  to  break  down,  which  leads  to 
minute  hemorrhages  into  the  growth  before  the 
breaking  down  is  extensive  enough  to  make  a 
breach  of  the  surface.  The  livid  surface  of  a 
cancer  spot  bleeds  on  being  rubbed,  so  that  a 
smooth,  dark  red  spot,  bleeding  on  contact,  is 
very  suspicious.  This  is  the  earliest  stage  of 
cancer  ;  and  if  there  is  a  nodule  that  can  be  felt, 
the  suspicion  is  still  stronger.  If  the  cancer  has 
so  advanced  as  to  form  a  growth  like  a  mush- 
room or  a  cauliflower,  the  diagnosis  can  scarcely 
be  doubtful. 

With  regard  to  microscopical  diagnosis,  Dr. 
Herman  thinks  that  the  value  of  the  microscope 
has  been  overestimated,  and  that  to  rely  upon 
its  use  may  lead  to  many  mistakes.  It  may 
now  and  then,  he  says,  reveal  cancer  in  a  doubt- 
ful case,  but  negative  microscopical  evidence 
should  never  be  trusted.  The  characters  seen 
with  the  naked  eye  and  the  behavior  of  the 
growth  should  always  be  taken  into  account  as 
well  as  its  histology,  and  if  the  two  conflict,  the 
behavior  is  the  more  trustworthy.  If  the  case 
is  a  doubtful  one,  behavior  of  the  suspicious 
part  under  treatment  is  the  best  test.  One  or 
two  applications  of  strong  carbolic  acid  will 
improve  the  local  condition,  and  the  diseased 
part  will  cease  to  bleed  on  contact.  If  the 
disease  is  cancer,  these  applications  will 
stirrfulate  its  growth,  and  the  local  changes  will 
be  more  pronounced  after  such  treatment. — 
Brit.  Med.  Jour. 

THE    ELECTRICAL    CURE     OE     CAN- 
CER. 

Under  this  caption,  in  tlie  Jiclcctic  Mai^azine 
for  May,  1892,  is  republished  an  excellent 
resume  of  the  literature  of  this  subject,  written 
by  Mrs.  Emily  Eaithlul,  and  originally  published 
in  the  Contemporary  Rcvieiv.  'I'he  gifted 
authoress  had  submitted  herself  to  the  knife 
twi<e  for  epithelioma  without  permanent  relief ; 


and  was  advised  to  submit  to  treatment  by  the 
galvanic  current,  which  she  did,  with  the  result 
that  so  far  had  "  been  absolutely  satisfactory." 
She  "  naturally  wanted  every  possible  confir- 
mation of  the  belief  which  had  become"  her 
sheet-anchor,  and  "  found  by  diligent  search 
that  it  existed  embodied  in  works  written  by 
many  hands  in  many  countries  and  through 
many  years,  all  maintaining  that  in  certain 
diseases  electricity  did  better  work  than  any 
knife  could  do."  The  results  of  her  search, 
collected  for  her  own  encouragement,  she  has 
therein  given  for  that  of  others  ;  and  has 
presented  the  conclusions  of  specialists  in  a 
terse  yet  comprehensive  sum.mary,  which  will 
well  repay  perusal  even  by  professional  readers. 

LIVING    PARASITES  IN    CARCINOMA. 

In  patients  suffering  from  carcinoma,  Kahane 
finds  in  blood  from  the  fresh  growth,  and  also 
from  the  finger  tip,  minute,  irregular,  amoeboid, 
highly  refractile  bodies,  which  he  regards  as 
parasites.  These  show  very  active  rotatory  and 
progressive  movements.  The  small  bodies  lie 
free  in  the  blood  stream,  and  also  within  the 
red  corpuscles.  The  movements  are  kept  up 
for  an  appreciable  time  afier  penetration 
of  the  corpuscle.  Kahane  thinks  that  further 
investigation  may  show  morphological  and 
biological  points  of  resemblance  between  these 
bodies  and  the  plasmodia  of  malaria.  Examina- 
tion in  the  fresh  stale  disclosed  similar  bodies 
within  the  cells  of  the  cancer.  The  growths 
examined  were  epitheliomata  situated  upon  the 
face,  prepuce  and  cervix. — Centralbl.  f.  Bakt., 
B.  XV,  12. 


TECHNIQUE 


OE     MAJOR 
TIONS. 


AMPUTA- 


Hr.  Crede,  of  Dresden,  said  that  within  the 
past  several  years   surgeons  seemed   to  have 
lost    interest    in    this    subject,    although  the 
methods    employed  were  far  from  being  satis- 
factory as  regards   the  healing   of  the   amputa- 
tion wound.     Union  by  first  intention,  also,  is 
not  always    the  rule.     The  best  estimate  of  the 
comparative  value  of  the  various   methods  is 
furnished   by   the  time   required  for  complete 
cicatrization.     He    attached  little    importance 
to  the   Esmarch   bandage,   avoiding  a  number 
of  ligatures  by  doing  without  it.     The  form  of 
the  flap  was  also  a   secondary  matter.     The 
important  point,  in  his  opinion,  was  to   cut  a 
flap  lined  with  a  thick,  muscular  layer,  as  the 
muscles  have  a  tendency  to  undergo  ultimate 
retraction.     He    abandoned  drainage   and  su- 
tures, and,  the  catgut  ligatures  being  made»  he 
approached  the  edges  of  the  flap  with  a  gauze 
Ixindagc,   applied  directly  uponthe   stumj)  in 
such   a   way  as  to  make  slight    compression, 
then   ap[)lied    the  dressing.     He  operated    in 


THE   CANADA    ^lEDICAI.    RECORD. 


IS 


this  way  on  twenty-two  cases,  all  of  which  did 
well,  two-thirds  healing  by  first  intention.  In 
the  other  third  small  areas  of  suppuration  pre- 
vented rapid  recovery,  but  in  no  case  was 
there  separation  of  the  wound,  as  occurs  fre- 
quently when  the  flap  consists  of  skin  only. 

Hr.  Gussenbauer,  of  Prague,  said  that  the 
only  new  feature  of  Crede's  method  was  that 
he  did  not  use  any  sutures  ;  but  it  was  doubt- 
ful if  this  was  an  advantage,  as  it  was  only  by 
sutures  that  the  edges  of  the  wound  could  be 
exactly  approximated.  He  had  also  long  aban- 
doned drainage  and  applied  a  compression  ban- 
dage directly  to  the  stump. —  Univ.  Med.  Jour. 

VENOUS  STASIS  IN  SURGICAL 
TUBERCULOSIS. 

Kr.  Bier,  of  Kiel,  stated   that  within  the  last 
two  years  he  had  treated  one  hundred   and 
eighty   cases  of   surgical    tuberculosis    of    the 
extremities  by  producing  venous  stasis.     The 
method  consists  in  wrapping  an  ordinary  ban- 
dage around  the  affected  member  as  far  as  the 
diseased  point,  and  placing  above  it  an  elastic 
band,  in  such  a  way  as  to  cause  venous  stasis 
of  the   diseased   area.     He    divided  his   cases 
into  two  classes, — those   with  and   those  with- 
out fistula.      In  cases  without   fistula,  a  nota- 
ble functional  amelioration    rapidly  occurred, 
and  a  painful  spot  appeared,  on   the  site  of 
which  an  abscess   formed.     The  spontaneous 
or  artificial  opening  of  this  abscess  leaves  a 
fistula.     To   avoid  this,  he  punctures  the  ab- 
scess with  the  needle  of  a  Pravaz  syringe,  and 
injects  iodoform,  first  evacuating  the  contents. 
In  this  way,  in  spite  of  the  abscess,  the  applica- 
tion  of  the    elastic  band  may  be   continued. 
However,  if  a  large  abscess  form,  it  is  best  to 
abandon  this  method  of  treatment.     In   cases 
where  a  fistula  already  exists,  the  use  of  the 
bandage  provokes  an  abundant  secretion,  and 
cure  is  rarely  obtained.     He  always  combines 
his   method  in  such   cases  with  injections  of 
iodcform-oil  or  zinc  solution.     In  cases  of  local 
tuberculosis,    not  opened,    the   plan  had  been 
satisfactory  in  his  hands,  and  he  had  even  ob- 
tained some  cures.     In  three  cases  of  tubercu- 
losis of  the    epididymis  and  testicle,    elastic 
constriction   brought   about  recovery  in  two. 
He  had  one  case  of  recovery  from  lupus  of  the 
face,   where   he    produced   venous   stasis    by 
means    of  cups.     He  considered   his  success 
sufficiently  encouraging,  and  recommended  the 
combination  of  his  method  with  iodoform  in- 
jections. 

Hr.  Zeller,  of  Berlin,  said  that  the  method 
had  been  successfully  tried  in  four  cases  with- 
out fistula  in  Sonnenburg's. clinic.  In  one  wo- 
man with  lupus  of  the  face  and  beginning  tu- 
berculosis of  the  wrist,  [complete  recovery 
of  the  latter  affection  had  taken  place. 
Whenever     the     case      was    a     recent    one, 


the  results  showed  the  efticacy  of  the  method. 
In  four  other  cases  the  combination  of  venous 
stasis  with  iodoform  injections  was  followed  by 
excellent  results,  one  child  with  tuberculosis  of 
the  knee  having  been  cured. — Deutsche  med. 
Zeitung,  May  21,  1894. 

CONSERVATIVE  TREATMENT  OF  HIP 
JOINT  DISEASE. 

Professor    Bruns,   of  Tubingen,  stated   thai 
various  changes   have  taken  place  in  the  treat- 
ment of  this  disease   during   the  past  twenty 
years,  and  even  now  surgeons  are  not  by  any 
means  of  one   mind  as  to  the  best   course  to 
pursue.     The   minority   still  hold  to  operative 
treatment,  whilst  the  majority  have   advanced 
to  a  more  conservative  and  expectant  line  of 
action.     Professor  Bruns  has  come  to  the  con- 
clusion  that  the   latter  shows  at  least  as  good 
results  as  the  former.     In  the  Tubingen  clinic 
during   the   last  forty  years,  600   cases    were 
treated,  and   later  examinations  were  made  in 
200  of  them.     From  the  data  at  his  command, 
it  was  shown  that  tubercular  hip-joint  disease, 
almost  without  exception,  occurred  before  the 
twentieth    year  of  life,    and    that  50  per  cent, 
recovered  after  four  years'  illness.     Forty  per 
cent,  of  all  cases  ended  fatally  from  tubercular 
disease  of  the  other  organs  or  general  tubercu- 
losis.    Of  the   non-suppurating  cases,  77   per 
cent,  recovered  ;  of  the  suppurative,  22  percent. 
The  prospect   of  recovery   became  worse  the 
higher  the  age.     Even   recovered  cases   often 
died  of  subsequent  tuberculosis.     Those  per- 
manently recovered  mostly   gave   the  impres- 
sion of  perfect  health,  and  showed  a  notewor- 
thy usefulness  of  the  limb  affected,  which  was 
only  limited  by  its  angular  position.     Asa  rule, 
a   partial    or  total   ankylosis    of  the  hip-joint 
remained.     As  regarded  usefulness,  the  short- 
ening of  the  limb  was  of  less  importance  than 
the    flexion   of-  the   legs.     Resection  gave  no 
belter  results   functionally  than  the  conserva- 
tive method  of  treatment,  and  should  only  be 
adopted  where  the   conservative   method  was 
impracticable,   or  where  it  had  been  tried  and 
led  to  no  result.     In    the  meantime,   however, 
Professor  Bruns    would    withhold  his  definite 
judgment,  as  a  sufficient  amount  of  experience 
with  the  modern  treatment  of  wounds  was  want- 
ing. 

Hr.  Schede,  of  Hamburg,  discussed  m  de- 
tail the  advantages  of  injection  of  iodoform 
glycerin  into  the  tuberculous  joint  which  in  a 
moiety  of  the  cases  rendered  resection  unneces- 
sary. 

Professor  Helferich,  of  Greifswald,  em- 
phasized the  necessity  of  long-continued  treat- 
ment. No  cure  was  brought  about  by  resec- 
tion and  cicatrization  of  the  wound.  If  treat- 
ment was  not  continued,  serious  disturbances 
were   certain   to  arise   later.     For  this    reason 


i6 


THE  CANADA  MEDICAL  RECORD. 


resection  could  npt  be  looked  upon  as  a  finality  ; 
care  had  also  to  be  taken  to  ensure  a  good  po- 
sition of  the  leg.  Generally,  those  who  were 
discharged  as  cured  after  resection  came  back 
again  later  in  a  bad  condition,  in  consequence 
of  an  unsuitable  mode  of  life  after  withdrawal 
from  medical  supervision.  Ankylosis  from 
this  cause  frequently  came  on  years  afterward. 
For  these  reasons  the  greatest  attention  should 
be  paid  for  years  to  the  hygienic  surroundings 
of  the  patient,  as  well  as  to  the  condition  of  the 
recovered  bone,  if  the  result  obtained  at  first 
was  not  to  be  jeopardized. 

Professor  Gussenbauer,  of  Prague,  repre- 
sented the  extreme  stand-point  of  conservative 
treatment  of  cases  of  tubercular  coxitis,  prefer- 
ring not  to  have  such  cases  touched. 

Professor  v.  l^ergmann  was  more  in  favor  of 
operative  treatment,  which,  in  cases  of  profuse 
suppuration,  was  the  only  course  open. 

Professor  Bramann,  of  Halle,  preferred 
resection  to  be  limited  to  those  cases  in  which 
the  acetabulum  was  known  to  be  diseased,  and 
referred  to  eleven  such  cases  in  which  he  had 
performed  resection. 

Professor  Madelung,  of  Rostock,  noted 
that  the  prospects  of  conservative  treatment 
became  better  when  the  patients  were  taught 
to  go  about  for  long  periods  in  a  suitable  ap- 
paratus.— Medical  Press  and  Circular.,  May 
i6,  1894. 

TREATMENT  OF  VARICOCELE. 
By  Stuart  McGuire,  M.D., 

Professor  of  Principles  of  Siir^^ery,  University 
College  of  Medicine^  Richniond,  Va. 

No  one  operation  should  be  employed  as  a 
routine  practice,  but  the  surgeon  should  select 
in  each  case  the  method  apparently  best  suited 
to  its  individual  requirements. 

The  following  is  an  operation  which  I  have 
employed  in  five  severe  cases  of- varicocele,  with 
uniformly  good  results.  It  is  not  original,  but 
is  merely  a  combination  of  the  essential  fea- 
tures of  the  methods  of  Bennett  and  Henry,  and 
consists  in  the  open  deligation  of  the  veins,  the 
shortening  of  the  spermatic  cord,  and  the  cur- 
tailment of  the  relaxed  scrotum. 
»  The  patient  is  anaesthetized,  and  the  scrotum, 
pubes  and  thighs  shaved,  well  scrubbed  with 
soap  and  water,  and  irrigated  with  a  bichloride 
solution.  The  vas  deferens  is  isolated  and  slip- 
ped behind  the  other  constituents  of  the  cord, 
and  the  veins  grasped  and  made  prominent  by 
the  fingers  and  thumb  of  the  left  hand.  An  in- 
cision about  an  inch  long  is  made  over  the  cord 
parallel  to  its  course,  and  the  veins,  covered  by 
their  sjieath,  exposed.  The  knife  is  now  laid 
aside,  the  vessels  not  having  been  denuded  of 
their  thin  investing  fascia.  By  means  of  an 
aneurism  needle,  a  catgut  ligature  is  passed 
around  the  aneuri!>m   at  the  lower  angle  of  the 


wound,  and  securely  tied.  The  veins  and  their 
fascia  are  then  freed  from  the  surrounding  parts 
for  an  inch  or  more  above  the  ligature,  and  a 
second  ligature  passed  around  them  at  the  up- 
per angle  of  the  wound,  and  tied.  The  ends  of 
both  ligatures  are  left  long.  'J'he  portion  of  the 
veins  between  the  two  ligatures  is  divided  above 
and  below,  about  a  quarter  of  an  inch  from  the 
ligatures,  and  removed.  One  end  of  each  liga- 
ture is  threaded  on  a  needle  and  passed  through 
the  end  of  the  stump  which  it  encircles,  and  is 
thus  made  to  emerge  at  a  point  opposite  the 
knot.  All  bleeding  is  now  carefully  checked, 
and  the  two  stumps  are  brought  together  and 
kept  in  accurate  contact  by  tying  the  corres- 
ponding ends  of  the  upper  and  lower  ligatures 
together.  The  ends  of  the  ligatures  are  cut 
short,  the  wound  irrigated  and  dried,  and  the 
incision  closed  by  interrupted  sutures. 

The  next  step  is  the  curtailment  of  the  scro- 
tum. The  testicles  are  pushed  up  against  the 
pubes,  and  the  scrotum  drawn  through  the 
blades  of  a  scrotal  clamp,  which  is  tightened  un- 
til it  firmly  grasps  the  skin.  The  clamp  is  ap- 
plied from  above  downward,  and  care  should 
be  taken  to  depress  it  well  towards  the  peri- 
neum, and  to  have  the  raphe  of  the  scrotum  in 
the  middle  line  of  the  condemned  tissue. 

Interrupted  silk  stitches  are  now  passed 
through  the  scrotum  on  the  distal  side  of  the 
clamp,  and  the  redundant  tissue  cut  away.  The 
clamp  is  then  removed,  bleeding  arrested,  the 
stitches  tied,  and  a  dressing  appHed. —  Virginia 
Med.  Monthly. 

SYPHILIS  OF  THE  TONGUE  AND  CAN- 
CER. 

There  is  no  doubt  that  the  condition  variously 
known  as  leucoma,  psoriasis  or  ichthyosis  of  the 
tongue  has  not  received  the  attention  to  which 
it  is  entitled  as  an  etiological  factor  in  lingual 
cancer.  This  affection  occurs  so  frequently  in 
persons  addicted  to  excessive  smoking  that  it  is 
sometimes  known  as  smoker's  tongue.  Accord- 
ing toCotterel.  however  {^Medical  Jl'ecl:),  who 
has  written  an  interesting  paper  on  this  subject, 
leucokeratosis,  as  he  terms  it,  is  frequently  of 
specific  origin,  although  it  may  be  difficult  to 
demonstrate  this,  on  account  of  the  absence  of 
other  concurrent  or  confirmatory  symptoms  of 
syphilis,  together  with  a  denial  on  the  part  of 
the  patient,  either  from  wilfulness  or  ignorance, 
that  he  has  had  syphilis.  In  some  cases  the 
lesion  seems  to  be  due  to  the  coaibined  action 
of  chronic  syphilis  and  smoking.  The  author 
calls  attention  to  the  frequency  with  which 
epithelioma  follows  this  form  of  leucokeratosis. 
and  makes  a  forceful  appeal  to  the  general  prac 
litioner  and  tlie  dentist  to  acquire  a  more  ihoi 
ough  knowledge  of  the  manifestations  likeh  • 
lead  to  cancer.  In  conclusion  he  states  : 
would  impress   the   necessity  of  very   carefui.; 


THE  CANADA  MEDICAL  RECORD. 


17 


watching  the  later  manifestations  of  syphihs  of 
the  tongue,  for,  though  we  are  not  aware  of  tlie 
direct  lelationship  between  syphihs  and  epithe- 
lioma, yet  the  former  disease  provides  in  the 
tongue  a  frequent  source  of  chronic  irritation  of 
the  epithelium.  This  chronic  irritation  is  very 
likely  to  be  followed  by  malignant  disease,  and 
this  fully  accounts  for  the  frequency  with  which 
one  observes  that  epithelioma  of  the  tongue  fol- 
lows certain  syphilitic  affections  of  that  organ." 
— Infer  national  Journal  of  Surgery. 


REMOVAL  OF  THE  TONGUE  FOR  CAN- 
CER. 

Mr.  H.  T.  Butlin  reports  a  series  of  forty-six 
consecutive  cases  in  which  at  least  half  the  ton- 
gue was  removed  for  cancer,  with  but  one  fatal 
result.  'J'he  great  majority  of  operations  were 
not  complicated  by  removal  of  the  lymphatic 
glands  or  ligature  of  the  lingual  artery.  Nine- 
teen of  the  patients  were  above  sixty  years  of 
age,  and  some  were  suffering  from  organic  dis- 
ease of  internal  organs.  All  the  operations 
were  performed  by  Whitehead's  method,  the  lin- 
gual artery  being  tied  in  those  cases  in  which 
the  disease  was  situated  wholly  at  the  base  of 
the  tongue,  and  in  those  in  which  the  situation 
of  diseased  glands  was  such  that  the  same  inci- 
sion was  suitable  for  ligature  of  the  artery.  The 
author  recommends  that  such  wounds  should 
be  drained  for  a  week  or  ten  days,  especially 
when  the  submaxillary  gland  has  been  removed. 
The  after-treatment  of  operation  on  the  tongue 
should  be  chiefly  directed  to  (i)  maintaining 
the  wound  in  an  aseptic  condition ;  (2)  dimin- 
ishing the  tendency  of  the  wound  secretions  to 
pass  down  the  air  passages  ;  (3)  preventing 
food  from  passing  down  the  trachea  into  the 
lungs.  The  first  indication  is  best  fulfilled  by 
frequent  application  of  iodot'orm  to  the  mouth 
wound  by  means  of  an  applicator ;  the  second 
by  keeping  the  patient's  head  low  and  letting 
him  lie  well  over  on  the  side  from  which  the 
greatest  amount  of  tongue  has  been  removed. 

The  feeding  of  these  patients  needs  very  great 
attention.  When  only  half  of  the  tongue — 
whether  a  lateral  half  or  the  front  half — or  two- 
thirds  has  been  removed,  liquids  can  generally 
easily  be  taken  on  the  day  following  the  opera- 
tion from  a  feeder  with  a  spout,  provided  a 
piece  of  India-rubber  tubing,  3  or  4  inches  long, 
be  fixed  on  to  the  spout.  If  the  right  half  of 
the  tongue  has  been  removed,  the  patient 
should  lie  over  on  the  left  side  during  feeding, 
so  that  the  food  is  kept  as  far  as  possible  away 
from  the  wound,  and  passes  over  the  parts 
which  have  been  least  interfered  with. 

When  the  whole  of  the  tongue  has  been  re- 
moved, the  difficulty  of  swallowing  is  much 
greater,  and  many  days  may  elapse  before  the 
patient  acquires  the  knack  of  swallowing  liquids 


without  permitting  a  small  quantity  to  pass 
down  the  air  tubes.  During  the  first  forty-eight 
hours  these  patients  are  fed  through  the  rectum 
with  nutrient  enemata.  At  the  end  of  that  per- 
iod the  patient  is  allowed  to  make  a  first  at- 
tempt to  swallow  a  little  liquid,  and  water  is 
chosen  for  the  experiment,  because  the  entrance 
of  a  little  water  into  the  trachea  is  seldom  fol- 
lowed by  any  serious  consequences.  Milk  and 
beef  tea  are  more  dangerous ;  they  hang  about 
the  air  tubes,  are  difficult  to  get  rid  of,  and  are 
very  prone  to  undergo  rapid  decomposition,  and 
occasion  the  much-dreaded  swallowing  pneumo- 
nia {Schlnck  pneumonic) .  If  the  experiment  is 
successful  other  liquids  may  be  tried,  and  the 
problem  of  feeding  is  really  overcome.  But  if 
there  is  any  difficulty,  the  patient  is  fed  as  long 
as  may  be  necessary  through  a  tube.  Butlin  be- 
lieves no  instrument  is  so  good  for  this  i)urpose 
as  a  black  bulbous  catheter,  about  No.  9  or  10, 
attached  to  a  long  piece  of  India-rubber  tubing, 
to  the  other  end  of  which  a  small  glass  funnel 
is  fixed. 

The  throat  is  first  sprayed  with  a  3  or  4  per 
cent,  solution  of  cocaine;  the  tubing  is  clamped 
with  forceps  just  above  the  attachment  of  the 
catheter,  and  the  funnel  and  tubing  are  filled 
down  to  the  clamp  forceps  with  warm  food. 
The  catheter  is  very  gently  passed  down  the 
pharynx,  and  hitches  at  the  posterior  border 
of  the  larynx.  The  patient  is  directed  to  swal- 
low, and  as  he  does  so  the  catheter  is  easily 
passed  on  into  the  oesophagus.  For  the  moment, 
discomfort  is  created,  and  the  patient  often 
struggles.  He  is  directed  to  close  his  mouth, 
and  no  attempt  is  made  to  pass  the  catheter  far- 
ther down  for  half  a  minute  or  longer.  Then  it 
is  slowly  and  gently  passed  down  to  a  distance 
of  about  II  inches  from  the  teeth.  When  the 
annoyance  of  the  presence  of  the  catheter  has 
ceased,  the  clamp  is  removed  and  the  food  is 
allowed  to  run  slowly  down  into  the  stomach. 
If  there  is  an  inclination  to  regurgitation  or  to 
cough,  the  descent  of  liquid  is  instantly  arrested 
by  pressing  on  the  tubing  with  the  finger  and 
thumb,  and  the  nurse  lowers  the  funnel  until  the 
(  dangerous  moment  has  passed.  By  attention 
i  to  these  details  a  pint  or  a  pint  and  a-half  of  li- 
quid may  easily  be  introduced  into  the  stomach 
without  danger.  Before  removing  the  catheter 
the  funnel  is  raised  high  up,  so  as  to  get  rid  of  the 
contents  of  the  tube,  and  during  the  actual  re- 
moval of  the  catheter  the  tubing  is  kept  tightly 
pressed  between  the  finger  and  thumb  in  order 
to  prevent  the  entrance  of  even  a  few  drops  in- 
to the  larynx.  When '  the  feeding  is  carefully 
carried  out  according  to  these  directions,  But- 
lin has  patients  so  satisfied  with  it  that  they 
have  sometimes  insisted  on  being  fed  through  a 
tube  for  a  much  longer  period  than  he  has 
deemed  necessary. 

— British  Med,  Journal . 


i8 


THE   CANADA   MEDICAL    RECORD. 


THE  CANADA  MEDICAL  RECORD 

riHLISllKll   MoXTllI.Y. 


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EDITORS : 

A.  LAPTHOflN  SMITH,  B  A.,  M.D.,  M.RC.S.,  Eng.,  F.OS 

London 
F.  WAYLAND  CAMPBELL,  MA  ,  M.D,  LR.CP  ,  London 

ASSISTANT  EDITOR 
ROLLO  CAMPBELL.  CM.,  M.D- 

Make  all  Cheques  or  P.O.  Money  Orders  for  subscription  or 
advertising  pavable  to  JOHN  LOVELL  &  SON.  23  St.  Nicho- 
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thould  be  addressed. 

All  letters  on  professional  subjects,  books  for  review  and 
exchanges  8houl<l  be  addressed  to  the  Editor,  Dr.  Lapthorn 
Smith.  248  Bishop  Street. 

Writers  of  original  communications  desiring  reprints  can 
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Editor. 

MONTEEAL,  OCTOBEE,  1894. 

THE     RAPID     CURE    OF    PROSTATIC 
HYPERTROPHY  BY  REMOVAL  OF 
THE  TESTES. 

The  effect  of  removal  of  the  ovaries  and  tubes 
upon  hypertrophic  conditions  of  the  uterus  has 
long  been  known,  and  has  been  one  of  the  prin- 
cipal methods  of  treating  uterine  fibroid  tumors. 
The  result  has  placed  the  fact  beyond  question 
that  the  ovaries  exert  a  powerful  influence  upon 
the  amount  of  blood  sent  to  the  uterus.  After 
removal  of  the  ovaries  the  uterus  as  a  rule 
shrinks  very  rapidly,  and  within  a  iQW  months 
may  be  reduced  to  one-fourth  its  former  size. 
Judging  by  analogy,  the  removal  of  the  organs 
of  sexual  stimulus  in  the  male  should  have  a 
similar  result  upon  the  prostate.  An  interest- 
ing discussion  on  this  subject  took  place  a 
few  months  ago  at  a  meeting  of  the  Medico. 
Chirurgical  Society  of  Montreal,  in  which  the 
gynaecologists  and  physiologists  took  part,  in 
which  it  came  out  very  clearly  that  the  pros- 
tate was  composed  of  muscles  and  blood-vessels 
and  some  fibrous  tissue  ;  that  it  was  developed 
most  largely  in  tliose  who  used  it  most,  and 
was  smallest  in  the  continent.  One  speaker, 
Dr.  Lapthorn  Smith,  stated  that  in  every  case 
of  enlarged  prostate  which  had  come  under  his 
notice,  the  owners  of  the  hypertrophied  organ 
had  confessed  to  him  that  they  had  been  given 
to  either  masturbation  or  inordinate  sexual  in- 
tercourse, and  he  had  suggested  that  in  cases 
where  there  was  too  much  muscle  in  the  organ 
there  had  been   too  much   use  of  it ;  while  in 


cases  where  there  was  too  much  fibrous  tissue 
in  it,  tills  was  due  to  venous  obstruction  due 
to  constipation,  as  was  the  case  in  fibroid  of 
the  uterus.  It  was  also  suggested  that  the 
testes  be  removed,  in  order  to  lessen  the  blood 
supply  of  the  organ  and  to  diminish  its  size. 
These  views,  which  were  thought  rather  chimer- 
ical at  the  time,  have  received  a  striking  con- 
firmation from  no  less  an  authority  than  Mr. 
Mansell-Moullin,  surgeon  to  the  London  Hos- 
pital, and  a  man  whose  opinion  carries  a  great 
deal  of  weight.  In  a  very  interesting  paper  in 
the  Medical  Pies':  and  Circular,  19th  Sept., 
1894,  he  reports  a  case  of  absolute  and  rapid  cure 
of  prostatic  enlargement  causing  retention  of 
urine.  The  patient  was  eighty-oae  years  of  age, 
and  the  growth  could  be  felt  by  the  rectum  as 
large  as  a  tangerine  orange.  There  was  reten- 
tion of  urine,  and  the  patient  was  rapidly  be- 
coming more  and  more  childish  as  his  strength 
gave  way.  Both  testicles  were  removed,  and 
to  quote  Mr.  Mansell-Moullin's  own.  words  : 
from  the  following  day  the  urine  came  more 
freely.  On  examination,  ten  days  after,  the 
prostate  as  felt  per  rectum  was  much  smaller. 
Three  weeks  after  the  operation  it  had  simply 
disappeared.  An  ordinary  silver  catheter, 
not  a  prostatic  one,  passed  in  easily  without 
requiring  to  be  depressed  more  than  usual  ; 
and  when  the  finger  was  introduced  into 
the  rectum,  all  that  could  be  felt  was  a 
fusiform  thickening  along  the  catheter,  not 
sufficiently  dense  or  large  to  prevent  the  shaft 
being  felt  distinctly  through  it  the  whole  way. 
The  bladder  was  beginning  to  regain  power, 
and  the  urine  had  become  acid.  He  refers 
then  to  a  similar  case  by  Prof  Ramm  of 
Christiania,  three  by  Dr.  Francis  Haynes  of  Los 
Angeles,  one  by  Dr.  Fremont  Smith,  a  seventh 
by  Prof  White  of  Philadelphia,  and  an  eighth 
by  Mr.  Arthur  Pavel  of  London. 

This  operation  must,  we  think,  be  considered 
as  one  more  triumph  for  surgery.  The  opera- 
tion of  castration  is  absolutely  devoid  of  danger 
with  modern  methods.  Pathologically,  the  fact 
that  the  enlargement  disappears  after  the 
testes  are  removed  is  no  less  interesting.  It 
establishes  the  purely  sexual  character  of  the 
prostate.  It  does  away  at  once  with  the 
theories  that  enlargement  is  dei^endent  upon 
senility  or  general  atheroma,  or  upon  hyper- 
trophy developed  in  compensation  for  sinking 


THE   CANADA   MEDICAL   RECORD. 


19 


of  the  floor  of  the  bladder.  He  condudes  his 
very  able  paper  by  saying  :  "  There  is  a  generally 
prevalent  idea  that  there  is  some  connection 
between  the  development  of  enlargement  of 
the  prostate  and  second  marriages  contracted 
late  in  life,  especially  when  the  wife  is  young. 
Without  going  so  far  as  to  say  that  the  disap- 
pearance of  enlargement  of  the  prostate  after 
ca&tration  proves  this,  it  may  be  admitted  that 
it  lends  it  a  certain  amount  of  support." 

THE  DIET   FOR  TYPHOID  PATIENTS. 

During  the  last  twenty  years  typhoid  fever  has 
been  gradually  becoming  a  much  less  fatal  dis- 
ease. This  is  no  doubt  partly  due  to  a  domesti- 
cation, so  to  speak,  of  the  former  wild  and  sav- 
age microbe,  but  also  very  largely  we  think 
to  improvements  in  the  management  of  these 
cases.  Formerly  they  were  kept  in  a  dark  room  ; 
now,  knowing  as  we  do  that  all  bacteria  thrive 
best  in  the  dark,  we  keep  the  typhoid  case  in 
the  sunniest  room  we  can  get.  Formerly,  for 
fear  of  catching  cold  and  chills,  he  was  kept  in 
a  hot  and  tightly  closed  room  without  ventila- 
tion ;  now  we  know  that  chills  mean  high  tem- 
perature, and  we  therefore  keep  our  patient 
cool  and  his  room  well  ventilated,  those  treated 
in  tents  in  the  open  air  making  the  best  recov- 
eries. In  the  use  of  water,  the  greatest  advances 
have  been  made.  Formerly  the  patient  was 
made  to  endure  his  intense  thirst,  or  at  best  it 
would  be  reHeved  by  salt  water,  alias  beef  tea. 
Now,  beef  tea  has  been  abandoned,  and  the 
patient  is  not  only  allowed  all  the  water  he 
craves  for,  to  wash  out  his  blood,  liver  and  kid- 
neys, but  his  temperature  is  kept  down  by  giv- 
ing that  water  icy  cold,  as  well  as  by  either 
immersing  him  in  a  moderately  cold  bath  or 
sponging  him  frequently  with  cold  water.  Thus, 
temperatures  of  105  and  106  are  rare,  while  the 
average  is  probably  less  than  103.  Another  ad- 
vance is  about  to  be  made.  In  the  July  number 
of  the  Australiayi  Medical  Journal  there  is  a 
paperbyDr.  J.  W.  Springthorpe,  entitled  "  A 
New  Food  for  use  in  Typhoid  and  other  Fevers," 
after  calling  attention  to  the  disadvantage  of 
milk,  the  principal  one  being  its  deficiency  in 
hydrocarbons,  its  curdling  and  fermenting, 
and  the  disgust  which  patients  come  to  have 
for  it.  In  place  of  milk  he  advocates  with  a 
good  deal  of  force  the  use  of  hopped  malt  ex- 
tract, in  which  the  bacillus  of  typhoid  will  not 


grow,  and  which  contains  all  the  elements  for 
sustaining  life  and  repairing  the  waste  of 
fever.  A  full  description  of  its  analysis  and 
advantages  over  milk  may  be  found  in  the  New 
Yqx\  Medic al Journal  oi  15th  Sept.,  1894.  An- 
other incidental  advantage  is  the  somniferous 
effect  of  the  lupulin  of  the  hops.  We  should 
not  be  surprised  to  see  a  good  sound  ale  that 
is  a  sterilized  hopped  malt  extract  accorded  a 
prominent  place  in  the  treatment  of  typhoid  in 
the  near  future,  as  many  cases  seem  to  do 
better  with  a  little  stimulant.  We  commend 
the  subject  to  our  readers'  consideration. 

A     PROVINCE     OF     QUEBEC      MEDI- 
CAL ASSOCIATION. 

It  was  with  feelings  of  no  slight  mortification 
that  those  who  went  from  this  province  to  the 
meeting  of  the  Canada  Medical  Association  at 
St.  John,  New  Brunswick,  were  obliged  to  con- 
fess that  there  was  no  Medical  Association  in  the 
Province  of  Quebec.  Ontario  has  a  splendid 
one.  Nova  Scotia  has  one.  New  Brunswick  has 
one,  and  so  has  even  the  little  province  of 
Prince  Edward  Island.  Why  this  province  has 
none  it  is  difficult  to  answer.  At  first  sight,  one 
might  think  that  this  was  because  the  profession 
is  partly  French  and  partly  English.  But  this 
can  hardly  be  a  reason  why  there  is  no  asso- 
ciation at  all,  although  it  might  explain  why 
there  might  be  two  associations.  Moreover, 
most  of  the  medical  men  of  the  province  under- 
stand both  languages  perfectly^  and  for  those 
who  did  not  there  might  be  an  official  language 
which  should  be  that  of  the  majority  of  mem- 
bers. We  earnestly  recommend  the  physicians 
of  each  town  or  village  to  form  a  local  society, 
electing  a  president  and  secretary,  and  to  meet 
at  each  other's  houses  once  a  month  and  talk 
over  their  cases,  or  even  to  read  a  paper  each 
in  turn.  Then  a  dozen  or  more  of  these  little 
societies  should  join  together  and  form  a  county 
society,  to  meet  every  three  months.  From 
that  to  a  provincial  society  would  only  be  a 
short  step.  We  would  be  pleased  to  publish 
in  our  columns  the  reports  of  these  meetings  as 
often  as  they  occur. 

Let  someone  in  each  parish  throughout  the 
province  at  once  take  this  matter  up,  and  we 
feel  sure  that  the  movement  will  be  productive 
of  the  greatest  good,  and  this  opprobrium 
which  has  so  long  existed  against  the  Province 
of  Quebec  will  at  last  be  removed. 


20 


THE   CANADA   MEDICAL   RECORD. 


ENGLISH  AS  A   UNIVERSAL  LAN- 
GUAGE. 

At  the   Saratoga  Meeting   of  the   American 
Social    Science  Association,  held   on  the   4th 
September,    Mr.   Porter   of  Waterbury,    Con- 
necticut, read  a   paper  on    the  above   subject, 
making   a  very  strong  and   convincing    argu- 
ment in   favor  of  the  English   language.     We 
have     always     held    that   the    English,    lan- 
guage   must  be  the   one  which   will  finally  be 
spoken  throughout   the   world.      The   advan- 
tages and   indeed  the  necessity  for  such  a  lan- 
guage were  very  clearly  manifested  at  the  Inter- 
national   Congress    at    Rome,   the    scientific 
value   of  which   was  very  seriously  marred  by 
the   polyglot  nature  of  the  proceedings,  which 
resembled  very  much  the  scene  pictured  in  our   \ 
mind  by  the  description  of  the  tower  of  Babel. 
There  is  no  doubt  a  great  deal  of  energy  wasted 
in  learning  half  a  dozen  languages^  when  two  at    | 
the   most  would   suffice,   namely,  the   mother    ' 
tongue  of  each  country  and  English.     Let  the 
French   schools  throughout  the    world    teach 
French  and  English,  the  German  schools  Ger- 
man  and  English,  the    Russian    schools  Rus- 
sian   and  English,  and  so  on,  and  the   result 
would  be  in  one  generation  there  would  be  one 
universal  language.    Medical  Hterature  would 
gain  enormously   thereby,  and  we  would  urge 
upon  all   our    foreign   exchanges    to   take  the 
matter   up  and  lay  it  before  their  lay  contem- 
poraries in  the  strongest  possible  light. 

ABOLISH    THE    DUTY    ON  ALCOHOL 
FOR  USE  IN  THE  SCIENCES. 

By  a  recent  change  in  the  United  States 
Tariff,  the  duty  on  alcohol  to  be  used  for  the 
above  purposes  has  been  removed,  and  tinctures 
will  thus  be  reduced  in  price  about  60  per 
cent.  This  will  be  a  great  boon  to  the  poor, 
who  must  need  medicine,  and  also  for  the 
medical  colleges  and  scientific  men  who  require 
alcohol  for  preserving  their  pathological  speci- 
mens. Many  instructive  pathological  s])eci- 
mens  have  been  lost  to  science  because  the 
medical  man  cannot  afford  to  spend  a  dollar  or 
two  on  alcohol  for  preserving  them. 

Why  should  not  a  similar  clause  be  passed 
at  the  next  session  of  the  Federal  parliament  ? 
We  should  have  a  sufficient  number  of  physi- 
cians  and  olliers  interested  in    scientific    pro- 


gress to  bring  the  matter  before  the  finance 
minister  in  a  forcible  manner.  In  this  and 
similar  cases  the  need  of  an  organized  section 
of  medical  M.P.'s  is  very  much  needed. 
There  is  at  present  a  sort  of  provision  permit- 
ting colleges  to  purchase  slightly  methylated 
spirits  in  bond  at  a  low  rate  of  duty;  but,  as  we 
recently  found  out  to  our  cost,  the  conditions 
are  so  irksome  as  to  be  practically  prohibitory. 
We  trust  that  the  other  journals  of  Canada 
will  join  us  in  an  effort  to  have  the  duly  remove^ 


PERSONAL. 

Dr.  F.  W.  Campbell  is  building  a  palatial 
residence  on  Sherbrooke  street,  at  the  corner  of 
Crescent  street,  with  a  smaller  but  very  hand- 
some house  next  door  for  his  son,  Dr.  Rollo 
Campbell.  We  feel  sure  that  all  the  readers 
of  the  Record  who  have  the  pleasure  of  know- 
ing our  genial  senior  Editor  will  wish  him  many 
years  of  life  and  health  in  his  new  home. 

Dr.  Lapthorn  Smith,  who  was  elected  second 
Vice-President  of  the  American  Electro-Thera- 
peutic Association  last  year  at  its  Chicago  meet- 
ing, was  this  year  promoted  to  the  honor  of 
President.  Cordial  invitations  were  offered  the 
Association  to  meet  in  Philadelphia  or  Montreal 
or  Toronto  next  year,  but,  after  carefully  con- 
sidering the  matter,  Toronto  was  accorded  the 
honor.  Dr.  Lapthorn  Smith  has  appointed  Dr. 
C.  R.  Dickson,  of  Toronto,  chairman,  and  Dr. 
Wolford  Walker,  of  Toronto,  secretary-treasurer 
of  the  Committee  of  Arrangements. 

We  are  glad  to  learn  by  the  Montreal  Sfar 
that  Dr.  T.  G.  Roddick  has  been  called  to 
Ottawa  to  attend  the  Premier  of  Canada,  Sir 
John  Thompson.  Apart  from  his  great  pro- 
fessional skill,  the  doctor  possesses  such  a  hap- 
py manner  and  expression  that  the  mere  sight 
of  him  would  make  the  sickest  person  feel  de- 
cidedly better,  ^^'e  congratulate  the  Premier 
on  his  choice. 

Dr.  Proudfoot  has  retired  from  the  position 
of  Oculist  to  the  Montreal  Dispensary.  For 
this  we  are  both  glad  and  sorry.  Glad  that  his 
private  practice,  in  addition  to  his  duties  at  the 
General  Hospital,  demand  so  much  of  his  time 
that  he  lias  none  to  spare  for  the  Dispensary  ; 
but  sorry  because  he  will  be  sincerely  missed  by 
the  poor  who  esteemed  him  so  highly,  as  evi- 
denced by  the  size  of  his  clinic,  one  of  the 
largest  there.  During  his  many  years  of  service 
he  has  won  the  esteem  not  only  of  the  patients 
but  of  the  whole  staff.  We  wish  him  continued 
prosperity  in  liis  new  sphere. 

Dr.  Roddick  has,  we  understand,  given  up  the 
specialty  of  Surgery  in  order  to  return  to  gen- 
eral   practice,    in    response  to    the    request   of 


THE   CANADA   MEDICAL   RECORD. 


21 


many  of  the  old  patients  of  the  late  Drs.  Howard 
and  Geo.  Ross,  who  felt  the  need  of  some  one 
to  take  tlieir  place,  as  well  as  of  many  j^racli- 
tioners,  who  required  an  experienced  consultant. 
Such  at  least  were  the  reasons  given  us  by  one 
who  was  in  a  position  to  know.  We  mention 
the  matter  as  an  item  of  interest  to  our  readers. 


LITERARY  NOTE. 

The  well-known  house  of  The  F.  A.  Davis 
o.,  of  Philadelphia,  will  issue,  shordy,a  work 
which  will  be  most  favorably  received  by 
the  Medical  profession.  It  is  entitled  Ob- 
stetric Surgery,  and  is  written  by  Drs.  Eg- 
bert H.  Grandin  and  George  W.  Jarman, 
gentlemen  who,  from  their  longconnection  with 
the  largest  and  most  widely  known  mater- 
nity hospital  in  the  United  States  (The  New 
York  Maternity  Hospital),  are  peculiarly  fitted 
to  expound  the  subject  from  the  modern  pro- 
gressive stand-point  of  election. 

There  is  no  work  in  any  language  which 
deals  with  the  surgical  side  of  obstetrics  so 
thoroughly  as  the  present.  The  rules  of  ob- 
stetric asepsis  and  antisepsis  are  so  de- 
scribed and  simplified  as  to  enable  even  the 
busy  general  practitioner  to  surround  his  pa- 
tients with  the  same  safeguards  as  are  guaran- 
teed in  well-ordered  hospitals.  The  subject  of 
pelvimetry,  without  due  regard  to  which 
modern  obstetric  surgery  cannot  exists  is  most 
tersely  and  exhaustively  treated  of.  The  in- 
dications under  which  artificial  abortion  and  the 
induction  of  premature  labor  properly  fall  are 
clearly  exemplified.  The  limitations  of  the 
forceps  and  of  version,  and  the  beneficent  re- 
sults to  be  secured  through  timely  resort 
to  symphysiotomy  and  the  Ccesarean  section, 
are  stated  with  the  accuracy  which  the  marve- 
lous progress  of  the  past  few  years  allows. 
The  surgical  aspects  of  the  puerperal  state  are 
carefully  described,  and  the  concluding  chap- 
ter deals  with  the  surgical  treatment  of  ectopic 
gestation. 

The  work  having  been  prepared  from  a 
teaching  stand-point,  the  terse  text  is  eluci- 
dated by  numerous  photographic  plates  and 
wood-cuts,  representing  graphically  various 
steps  in  operative  technique.  The  student  and 
the  practitioner,  thus,  not  alone  may  read  what 
to  do,  but  may  also  sec  how  to  act. 

The  work  is  not  burdened  with  literature 
references.  The  authors  have  aimed  to  teach 
that  which  ample  and  prolonged  experience 
has  taught  them  is  ^ood.  The  net  price  of  the 
volume  will  be  $2.50,  and  it  will  be  printed  in 
large,  clear  type,  on  excellent  paper,  and  hand- 
somely bound  in  extra  cloth.  The  full-page 
plates,  about  14  in  number,  will  be  printed  on 
fine  plate  paper,  in  photogravure  ink. 


A  companion  volume,  dealing  in  the  same 
terse,  practical  manner  with  pregnancy,  nor- 
mal labor,  and  the  physiological  and  patholo- 
gical i)uerperium,  is  in  active  preparation  by 
the  same  authors. 

LITERARY  NOTE. 

An  important  new  book  just  announced  is 
"  Practical  Uranalysis  and  Urinary  Diagno- 
sis." A  manual  for  the  use  of  Practitioners  and 
Students,  with  numerous  illustrations,  includ- 
ing colored  photo-engravings.  By  Charles  W. 
Purdy,  M.D.,  of  Chicago,  author  of  "  Bright's 
Disease  and  Allied  Affections  of  the  Kidneys;" 
"Diabetes:  Its  Causes,  Symptoms  and  Treat- 
ment," etc.  A  one-volume  practical  and  sys- 
ten.'atic  work,  of  about  350  crown-octavo  pages, 
in  two  parts,  subdivided  into  twelve  sections, 
and  an  appendix. 

Part  I  is  devoted  to  the  general  subject  of 
analysis  of  urine,  treating  in  detail  of  urine 
composition,  organic  and  inorganic  constitu- 
ents of  normal  and  abnormal  urine,  physical 
characteristics,  volumetric,  gravimetric,  centri- 
fugal, and  all  other  methods  of  analysis.  The 
various  processes  and  methods  of  detection,  de- 
termination, calculation,  etc.,  of  all  patholo- 
gical manifestations  and  substances  in  the  urine, 
with  their  causes  and  clinical  significance, 
including  the  urine. as  a  toxic  agent  all  forms 
of  urinary  sediments,  casts,  etc.,  aie  discussed 
with  great  clearness  and  force. 

Part  II  is  devoted  to  urinary  diagnosis,  and 
discusses  fully  all  forms  of  urinary  and  renal 
diseases,  including  anatomical  considerations, 
regional  relations  of  the  kidneys,  ureters, 
bladder  and  the  renal  pelvis,  also  their  physi- 
cal examination,  etc.,  chnical  diagnosis  of  uri- 
nary and  renal  diseases,  such  as  renal  tuber- 
culosis, cancer,  diabetes  insipidus,  diabetes 
melHtus,  misplacements  of  the  kidney,  cystitis, 
uraemia,  chyluria,  vesical  stone,  etc.  The  diag- 
nostic value  of  the  urine  in  acu^e  infectious 
diseases,  such  as  typhoid,  yellow  and  typhus 
fevers,  scarlatina,  cholera,  diphtheria,  variola, 
cirrhosis  of  the  liver,  jaundice,  acute  rheuma- 
tism, gout,  meningitis,  hysteria,  epilepsy,  pul- 
monary tuberculosis,  pneumonia,  pleurisy, 
bronchitis,  etc.,  are  clearly  and  scientifically 
set  forth,  the  author  giving  special  prcminence 
to  the  relations  of  the  chemistry  of  the  urine 
to  physiological  processes  and  pathological 
facts. 

In  the  appendix  is  presented  the  highly  im- 
portant subject  oF  examination  of  urine  for  life- 
insurance,  wherein  full  and  explicit  rules  for 
the  thorough  physical,  chemical  and  micro- 
scopical examination  of  the  urine  of  applicants 
for  life-insurance  are  given,  and  the  informa- 
tion here  presented  is  of  the  greatest  value  to 
every  physician  who  examines  for  life-insur- 
ance companies. 


22 


THE   CANADA   MEDICAL   RECORD. 


This  is  the  first*  American  work  of  a  com 
prehensive  character  for  more  than  a  decade  in 
this  department  of  practical  medical  science, 
and  it  should  meet  with  a  cordial  reception  by 
the  medical  profession  everywhere. 

It  has  been  the  special  aim  of  the  author  to 
furnish  the  student,  physician  and  surgeon,  in 
one  convenient  volume,  the  essential  features 
of  our  present  knowledge  of  the  urine  and 
urinary  diagnosis,  thoroughly  up  to  date  and  in 
a  systematic,  concise  and  practical  form,  so 
that  students  and  practitioners  who  obtain  this 
work  will  secure  the  fullest  as  well  as  the 
latest  trustworthy  information  on  this  impor- 
tant subject  without  the  necessity  of  iheir  pro- 
curing the  larger  and  more  expensive  works. 

The  well-known  house  of  The  F.  A.  Davis 
Company,  1914  and  191 6  Cherry  St.,  Phila- 
delphia, will  issue  the  work  shortly.  The 
book  will  be  first-class  in  quality  of  paper, 
press  work  and  binding,  and  the  price  most  rea- 
sonable,   namely,  $2.50,  net,  in  extra  clbth. 


BOOK  NOTICES. 

Manual    of  Obstetrics,  Gynecology  and 
Pediatrics.     By  Kenneth    N.    Fenwick, 
M.A.,   M.D.,  Prof.    Obstetrics    and  Dis- 
eases of  Women  and  Children,  Royal  Col- 
lege of  Physicians  and   Surgeons  in  affilia- 
tion with  Queen's  University,   Kingston  ; 
Member  of  Royal  College  of  Surgeons, Eng- 
land ;  Fellow  of  the  Obstetrical   Society, 
Edinburgh  ;  and  Surgeon  to  the  Kingston 
General    Hospital.      Kingston,    Ontario  : 
John  Henderson  &;  Co.,  1889. 
This  handy  manual  is  evidently  from  the  pen 
of  one  who  has  had  large  experience  in  teaching 
the  subject  whereof  he  writes,  and   is  therefore 
useful  not  only  to  students  but  also  to  teachers  of 
Gynx'cology  and  Obstetrics.  The  first  124  pages 
are  devoted  to  Obstetrics,  the  next  72  to  Gynae- 
cology, and  the  last  40  to  Diseases  of  Children. 
By  clearness   and  conciseness   of  style  it  is  as- 
tonishing how  much  the  author  has  managed  to 
get  in  within  the  limits  of  his  work.     It  is  ren- 
dered still  more  valuable  for  students  by  means 
of  ruled  interleaves  between    the  jjrinted  pages 
which  are    to   be   used  for  note  taking.     The 
binding  is   attractive,  and  altogether  the  book 
does  honor  to  the  Canadian   who  has  first  ven- 
tured to  write  a  work  on  (iynrecology  and  Ob- 
stetrics. 

A  New  Illustrated  Dictionary  of  Medi- 
cine, Biology,  and  Collateral  Sciences. 
I^r.  George  M.  Gould,  already  well  known  as 
the  editor  of  two  small  Medical  Dictionaries, 
has  now  about  ready  an  unabridged,  exhaustive 
woik  ol  the  same  class,  upon  wiiich  he  and  a 
corps  of  able  assistants  have  been  uninterrupt- 
edly engaged  for  several  years. 

The  feature  that  will  attract  inuuediate  atten- 


tion is  the  large  number  of  fine  illustrations  that 
have  been  included,  many  of  which — as,  for 
instance,  the  series  of  over  fifty  of  the  bacteria 
— have  been  drawn  and  engraved  especially  for 
the  work.  Every  scientific-minded  physician 
will  also  be  glad  to  have  defined  several  thou- 
sand commonly  used  terms  in  Biology,  Che- 
mistry, etc. 

The  chief  point,  however,  upon  which  the 
editor  relies  for  the  success  of  his  book  is  the 
unique  epitomization  of  old  and  new  knowledge. 
It  contains  a  far  larger  number  of  words  than 
any  other  one-volume  medical  lexicon.  It  is  a 
new  book,  not  a  revision  of  the  older  volume. 
The  pronunciation,  etymology,  definition,  illus- 
tration, and  logical  groupings  of  each  word  are 
given.  There  has  never  been  such  a  gathering 
of  new  words  from  the  living  literature  of  the 
day.  It  is  especially  rich  in  tabular  matter,  a 
method  of  presentation  that  focuses,  as  it  were, 
a  whole  subject  so  as  to  be  understood  at  a 
glance. 

The  latest  method  of  spelling  certain  terms, 
as  adopted  by  various  scientific  bodies  and  au- 
thorities, have  all  been  included,  as  well  as  those 
words  classed  as  obsolete  by  some  editois,  but 
still  used  largely  in  the  literature  of  to-day.  and 
the  omission  of  which  in  any  work  aiming  to  be 
complete  would  make  it  unreliable  as  an  ex- 
haustive work  of  reference. 

The  pul.tlishers  announce  that,  notwithstand- 
ing the  large  outlay  necessary  to  its  production 
on  such  an  elaborate  plan,  the  price  will  be  no 
higher  than  that  of  the  usual  medical  text-book. 
Attfield's  Chemistry.     Fourteenth    edition. 
Chemistry, — General,   Medical  and  Phar- 
maceutical ;  including    the   Chemistry  of 
the   U.S.    Pharmacopoeia.     A  Manual    of 
the    General   Principles   of  the    Science, 
and   their   application    to    Medicine   and 
Pharmacy.  By  John  Attfield,  M.A.,  Ph.D., 
F.I.C.,  F.C.S.,  F.R.S.,    etc.,  Professor  of 
Practical   Chemistry   to  the    Pharmaceu- 
tical Society  of  Great  Britain,   etc.    Four- 
teenth  edition,    specially   revised   by  the 
author  for  America  to  accord  with  the  new 
U.S.    Pharmacopeia.     In    one  handsome 
royal  121110.  volume  of  794  pages,  with  88 
illustrations.  Cloth,  $2.75  ;  leather,  $3.25. 
Philadelphia,  Lea  Brotiiers  &  Co.,  1894. 
If  the  success  of  a  work  can  be  measured  by 
t'.ie  number  of  its  editions,  Attfield's  Chemistry 
can  lay  claim  to  unexampled  ])opularity.     The 
author   has    evidently    clearly    discerned    the 
needs  of  students  of  Medicine  and  Pharmacy, 
as  well  as  those  of  physicians  and  pharmacists. 
He  deals  with  the  .y^/tv/a' of  chemistry  and  with 
the  chemistry  of  every  substance  having  inter- 
est for  the  followers  of  Medicine  and  Pharmacy, 
devoting  to  it  such  space  and  detail  as   is  indi- 
cated by  its  practical  importance.  The  present 
edition  contains  such  alterations  and  additions 
as  seemed   necessary  for  the  demonstration    of 


THE   CANADA   MEDICAL   RECORD. 


the  latest  developments  of  chemical  principles 
and  the  latest  applications  of  the  science  to 
medicine  and  pharmacy.  It  has  been  brought 
into  thorough  conformity  with  ilie  new  United 
States  Pharmacopceia. 

A  Treatisk  on  the  Principles  and  Practice 
OF  Medicine.     Designed   for  the   use  of 
Students   and  Practitioners    of  Medicine. 
By  Austin  Fhnt,  M.D.,  LL.D.,  Professor  of 
the  Principles    and  Practice    of  Medicine, 
and  of  Clinical  Medicine  in  Bellevue  Hos- 
pital   Medical  College,    N.Y.     New  (yth) 
edition.     In    one   very   handsome   octavo 
volume    of  1143  pages,  with  illustrations. 
Cloth,  $5.00;    leather,  $6.00. 
The  many  large  editions    of  this  great  work 
demanded  since  its  first  appearance  thirty  years 
ago  have   firmly  established  it   as  the  leading 
text-book  for  American    students   and  as    the 
cliief  dependence  of  the    American  physician. 
The  reasons  for  its  unexampled  popularity  lie  in 
its  peculiar  adaptation  to  the  needs  of  the  whole 
continent.  The  author's  unparalleled  experience 
covered  all   classes  and   conditions  of  men  in 
civil  and  military  practice,  on   the  frontier,  in 
the  country  or  in    the  city,  in    private    life  and 
in  hospital's,  in  the  North  and  the  South.     With 
exceptional   powers   of   observation  and  great 
literary  aptitude,  he  was  especially  fitted  to  pre- 
pare those   descriptions    of  disease  which  are 
and  will  continue  to  be  recognized  as  classics. 

In  the  present  issue  the  work  has  been 
thoroughly  revised  by  the  eminent  editor,  who 
has  made  such  changes  as  were  necessary  in 
order  to  represent  the  present  state  of  medical 
science  and  art.  He  has  greatly  enriched  the 
sections  on  treatment,  making  them  fully  repre- 
sentative of  the  great  advances  witnessed  during 
recent  years  in  the  department  of  Therapeutics. 
Flint's  great  Practice  is  therefore  again  put  forth 
in  the  full  confidence  of  universal  recognition 
as  the  foremost  American  text-book  and  work 
of  reference. 

The  Graphic  History  of  the  Fair.     A  su- 
perb  volume.   1,300  illustrations.   240  Im- 
perial quarto  pages  (11  x  16  in.). 
The  History  opens  with  an  introductory  chap- 
ter on  previous  World's  Expositions,  followed 
by  a  brief  survey  of  the  preliminary  organization, 
with  the  resulting  legislation  and   other  events 
culminating  in  the   creation  of  the    marvelous 
"  White   City."  Then  follow   chapters    on  the 
various  departments  of  the  Fair,  describing  each 
in  detail. 

The  great  merit  of  the  Graphic  History  is  due 
to  the  exceptional  advantages  accruing  from  the 
service  of  the  Graphic  staff  of  artists  and  en- 
gravers extending  over  the  entire  Exposition 
period,  aided  by  the  special  photograph  privi- 
lege accorded  by  the  Director-General,  from 
access  to  the  entire  photographic  collection  of 
the  official  photographer,  and  from  the  co-oper- 
ation of  the  Chiefs  of  Departments  and  foreign 
commissioners. 


Cloth,  $4.00  ;  full  morocco,  $6.00  ;  half  niir- 
rocco,  $5.00;  edition  de  luxe,  $10.00.  The 
Graphic  Company,  358  Dearborn  St..  Chicago, 
U.S  A. 


PAMPHLETS. 

A    Method  of  Performinc-    Rapid  Manual 
Dilatation  OF  the  Os   Uteri,   and   its 

ADVANfTAGES  IN  THE  TREATMENT  OF  PLAC- 
ENTA Previa.  By  Philander  A.  Harris, 
M.D.,  Obstetrician  to  the  Paterson  General 
Hospital.  Reprinted  from  the  American 
Journal  of  Obstetrics,  Vol.  xxix,  No.  3, 
1894.  New  York  :  William  Wood  &  Com- 
pany, publishers,  1894. 
A  Critical  Study  of  the  Biceps  C  ruris  Mus- 
cle   AS  IT    relates   to  DISEASE    IN    AND 

AROUND  THE  Knee-Joint.  Bv  Eliza  M. 
Mosher,  M.D.,  of  Brooklyn,'  N.Y.  Re- 
print from  Annals  of  Surgery,  November, 
1891. 

What  are  the  Indications  F(jr  Abdominal 
Section  in  Intra-Pelvic  Hemorrhage  ? 
By  Marcus  Rosenwasser,  M.D.,  Professor 
of  Diseases  of  Women  and  Abdominal 
Surgery  in  Wooster  University,  Cleveland, 
O.  Reprinted  from  the  Transactions  of 
the  American  Association  of  Obstetricians 
and  Gyntecologists.     1893. 

The  DuTif  of  thf.  Community  to  Medical 
Science.  By  George  M.  Gould,  A.M., 
M.D.,  Philadelphia.  Reprinted  from  the 
Bulletin  of  the  American  Academy  of 
Medicine.     No.  16. 

The  Pernicious  Influence  of  Albinism 
UPON  the  Eye.  By  George  M.  Gould, 
A.M.,  M.D.,  Ophthalmologist  to  the  Phila- 
delphia Hospital.  Reprinted  from  Annals 
of  Ophthalmology  and  Otology,  Vol.  II, 
No.  3,  July,  1893. 

Madame  Boivin.  By  Hunter  Robb,  Associate 
in  Gynaecology.  Read  before  the  Johns 
Hopkins  Hospital  Historical  Club,  April 
9,  1894.  From  the  Johns  Hopkins  Hos- 
pital Bulletin,  No.  40,  May,  1894. 

The  Relations  of  Urinary  Conditions  to 
Gyn.ecological  Surgery.  By  Charles 
P.  Noble,  M.D.  .Reprint  from  American 
Medico-Surgical    Bulletin,  October,  1893. 

The  Influence  of  Morbid  Conditions  of  the 
Uterine  Adnexa  upon  Reflex  Pheno- 
mena. By  Charles  P.  Strong,  M.D,, 
Assistant  in  Gynaecology,  Harvard  Medi- 
cal School  ;  Physician  to  Out-Patients, 
Massachusetts  General  Hospital ;  Assis- 
tant Surgeon,  Free  Hospital  for  VV^omen. 
Reprinted  from  the  Boston  Medical  and 
Surgical  Journal  of  January  12,  1893. 
Boston  :  Damrell  &  Upham,  publishers. 
No.  283  Washington  Street,  1893. 

An  Operating  Table.  By  Hunter  Robb,  M.  D., 
Associate  in-Gynoecology. 


THE   CANADA   MEDICAL   RECORD. 


NoTlS    ON    GV.N.ECOLOGICAL    TECHNIQUE.       By 

Hunter  Robl;,  M.I).,  Associate  in  Gynae- 
cology, Jolins  Hopkins  University,  Balii- 
more,  Md.     Reprint  from  tlie  New  York 
Journal  of  Gynaecology  and  Obstetrics. 
Stomatitis   Neurotica   Chronica.      By   A. 
Jacobi,    M.D.,   Clinical  Professor    in    the 
College  of  Physicians  and  Surgeons  (Col- 
umbia College),  New  York.     Reprinted 
from  the  Transactions  of  the  Association 
of  American  Physicians.  1894. 
Eleventh  Annual  Announcement  of  the 
Medical  and  Dental  Departments  of 
THE  National  University,   1894-1895. 
Mt.  Vernon  Square,  cor.  8th  and  K  Streets 
N.W.,  Washington,  D.C. 
The  Etowah  County  (Ala.)  Medical  So- 
ciety vs.  Dr.  William  Thomas  Coggin. 
Dr.  William  Thomas  Coggin,  of  Athens, 
Ga.,  who    claims  the  honor  of  doing  the 
first   symphyseotomy  in   this   country,  is 
denounced  by  the  Etowah  County  (Ala.) 
Medical  Society   as    an    imposter  and   a 
fraud.  Reprint  from  the  Alabama  Medical 
and  Surgical  Age,  June  number,   1894. 
Twelfth     Annual  Announcement  of  the 
Medical  Department  of  Niagara  Uni- 
versity, 1894-95. 
Niagara   University  was  founded  as  a  semi- 
nary of  learning  in  1856,  and  has  steadily  in- 
creased in   growth  and  power  until  it  has  now 
become  one  of  the  leading  educational  institu- 
tions of  the  country.     It  is  beautifully  located 
on  Niagara   River,  near  the  famous   cataract, 
Niagara  Falls,  and  offers  excellent  opportuni- 
ties for  the  education  of  young  men  in  the   fol- 
lowing departments  :  Department  of  Arts,  De- 
partment  of  Theology.    Department  of  Medi- 
cine. For  catalogues  and  information,   address 
very  Rev.  P.  V.  Kavanagh.  C.M,^  Suspension 
Bridge,  N.Y. 

Asepsis  in  Minor  Procedures.  By  Hunter 
Robb,  M.D.,  of  Baltimore.  Reprinted 
from  the  Maryland  Medical  Journal,  May 
19,  1894. 
The  Employment  of  the  Electro-Mag- 
net in  Ophthalmic  Practice.  By 
Robert  Winthroj)  Gillman,  M.D.,  Detroit, 
•'  Mich.  Ophthalmic  Surgeon  to  St.  Mary's 
Hospital,  Ophthalmologist  to  the  Woman's 
Hospital  and  Foundling's  Home,,  etc. 
Read  before  the  Annual  Meeting  of  the 
Michigan  State  Medical  Society. 


PUBLISHERS  DEPT. 

ori.VlES  i\UT  TU  BE  PREFERRED. 
Pain,  while  being  conservative,  is  oftentimes  unkind, 
and  must  neeiis  be  modified  and  controlled.  Reme- 
dies like  moipliia  whicli  lie  up  the  secretions  are  often 
objectionable.  Antikamnia  lias  no  such  unfavorable 
effects.  As  a  reliever  of  neuralgia  dependent  upon  wiiat- 
ever  cause,  and  rheumatism  and  gout,  it  is  of  great  value. 


In  the  intense  pains  ever  present  in  the  pelvic  distur- 
bances of  women,  cellulitis,  pyosalpinx,  et  al.,  it  is  to  be 
preferred  over  opiates. 

This  drug,  for  convenience  and  accuracy  of  dosage,  is 
now  prescribed,  to  a  great  extent,  in  the  tablet  form. 
Patients  should  be  instructed  to"  crush  the  tablet  before 
taking,  thus  assuring  celerity. 

The  manufacturers  have  thrown  around  tlieir  product 
the  security  of  specially  protected  packages,  for  both  pow- 
der and  tablets.  And  each  tablet  bears  a  monogram  indi- 
cating its  composition.  Physicians  should  therefore  insist 
on  the  presence  of  these  conditions. 

AN    AUTUMN  MAGAZINE. 

Tliat  popular  New  York  clergyman,  the  Rev.  Dr. 
Rain^ford,  contributes  a  most  interesting  article  to  the 
October  issue  of  The  Ladies''  Home  youriial^  in  whichie 
defines  the  position  of  "The  Clergyman  in  Soci'  v' 
Not  less  interesting  is  the  eminently  practical  view  w.  h 
Mrs.  Burton  Harrison,  in  her  contribution  to  the  series 
"  Before  He  is  Twenty,"  takes  of  "A  Boy's  Evenings 
and  Amusements" — how  the  first  should  be  spent,  and 
oi  what  the  second  should  consist.  Mr.  Howells'  liter- 
ary biography,  which  he  has  so  aptly  named  "  My  Lit- 
erary Passions,"'  continues  to  grow  in  interest  and  charm. 
Avery-  valuable  article  entitled  "The  Candy-Eating 
Habit"  is  furnished  by  Cyrus  W.  Edson,  M.D.,  Presi- 
dent of  the  New  York  Board  of  Health.  The  biography 
of  the  number  consists  of  sketches,  with  portraits  of  A. 
Conan  Doyle,  the  cre.itor  of  "  Sherlock  Holmes,"  and 
James  Matthew  Barrie,  the  author  of  "A  Widow  in 
Thrums  "  The  full  piano  score  of  the  Rose  Bud  Waltzes, 
specially  written  for-  the  younial  by  Luigi  Arditi, 
Patti's  veteran  orchestral  conductor,  cannot  fail  to  de- 
light all  lovers  of  good  music,  as  "  The  Possibilities  of 
Crepe  Paper'  and  "The  Holly  and  Mistletoe  on  China" 
will  all  lovers  of  the  artistic.  The  editor  discourses  with 
much  earnestness  on  what  constitutes  a  successful  life  for 
men  and  women,  and  Addison  B.  Burk  very  thoroughly 
explains  t  :e  methods  employed  in  the  building  and  loan 
plan — •'  When  Buying  a  House  with  Rent  Money." 
Much  solid  wisdom  may  be  found  in  Bunlette's  inimita- 
ble "Through  Two  Ends  of  a  Telescope."  Mrs.  Mallon 
contributes  some  charming  suggestions  for  "  Dainty 
House  Gowns"  and  for  "Little  Girls'  Gowns,"  and 
Miss  Hooper  speaks  some  wise  words  on  "  Dressing  on 
a  Small  Income."  Altogether  this  October  issue,  with 
its  attractive  cover,  specially  designed  by  A.  B.  Wen- 
zell,  is  an  ideal  magazine  and  worth  ten  times  its  price 
of  ten  cents.  The  Ladies'  Heme  younial,  with  a  circula- 
tion of  700,000  copies,  is  published  by  The  Curtis  Pub- 
lishing Company,  of  Philadelphia,  for  ten  cents  per  num  • 
ber  and  one  dollar  per  year. 

LITERARY  NOTES. 
From  the  Ladies''  Home  Jjurnal,  Philadelphia. 

l"or  the  first  time  in  his  literary  career,  Jerome  K. 
Jerome  is  about  to  write  directly  for  an  American  audi- 
ence. This  work  consists  of  a  series  of  papers  similar  in 
vein  to  his  "  Idle  Thoughts  of  an  Idle  Fellow,"  but  ad- 
dressed to  American  girls  and  women.  The  articles  will 
begin  shortly  in  The  Ladies^  Home  yourna/,  which  per- 
iodical will  print  the  entire  series. 

Bret  Ilartc  is  writing  a  story  of  American  life  and  in- 
cident for  T/ie  Ladies''  Home  younial. 

Frank  Stockton  has  given  both  of  his  new  stories,  with 
the  quaint  titles  of  "  Love  Before  Breakfast  "  and  "  .\s 
One  Woman  to  Another,"  to    The  Ladies  Home  yourtiaU 

The  suit  of  Dr.  Amick  against  the  St.  Louis  Clinique 
and  Faculty  of  the  College  of  Physicians  and  Surgeons, 
of  St.  Louis,  has  been  decided  in  favor  of  the  plaintitT. — 
Am.  Med.    'yt'iinial. 


^^mf'' 


m 


m^- 


Vol.  XXEII 


MONTRE  VL,  NOVEMBER,  1894. 


No.  2. 


ORIGINAL  COMMUNICATIONS. 

Three  Cases  of  C(vlii>tomy  :  An  <  )va- 
riau  Cyst  :  A  Tubal  Pregnancy: 
and  a  Hoematonia  of  tlie  <  >vary.         2") 

Double  Femoral  Herniotoniy  in  a 
Woman  lU  yea's  of  age  ;  Primary 
Union  of  Both  Woumls 'JS 

Kxtract  of  President's  A<ldress  be- 
fore Nova  Seotia  Medieal  Society  .    2S 


SOOETY  PKOCEEDINGS 

Tlie  Montreal  .Medico-rhirnrijical 
Society ... 

A  Case  of  Svmph vsiotomy 

Old  Dislocation  "of  the  Hiii-.Ioint 
Treated  by  Keseelion 

Resection  of  the  Intestines   

A  Case  of  Pylorectomy 

An  Appendix  containing  an  <  )rdinary 
Pin  as  the  Exciting  Cause  of  Per- 
forating Appendicitis 

Calcareous  Tumm-  of  the  Thyroid 
uroducing  ^Esophageal  <)l)struc- 
rion  

Tumor  of  the  Prostate   ...    

Four  Calculi  weighing  ."i  ounces  I 
ilrachm  removed  from  the  Bladder 


Case*  of  CholeiiNstotomv  3r> 

l{i>neii  Medical  Socictv   :!7 


PROGRESS  OF  SCIENCE- 

Canci'r  a  I,iM-al  Disease   .3S 

Xe\v<  ilisiTV.it  ion,>  in  (ionoirluca.  .  .  .  :;S 

-Vna^sthesia       :>S 

(Jriiwin.ii  Pains     .., US 

Treatment  of  Hydrocele :\% 

Accentuation     of     the     Pulni' nary 

Sound  in  Perityphlitis .js 

Itare  Case  cd  Traumatic  Cvst  of  tlic 

Stomach 30 

Homes  tor  Consumptives .!<) 

New  VIetliod  of  Exannning  f(  r  Renal 

Calculus....                      '              40 

Primary  Cancer  of  the  Gall-lil.addcr.  40 

The  Crine  in  Enteric  Fever  40 

An  Extreme  Case  of  Ascites 4(1 

UeuHl  Ha'morrhagefrom  an  unusual 

Source     ...  40 

Water  in  Typhoid  Fever 41 

Treatment  of  Red  Nose 41 

Second-Hand  Syringes 41 

Kentucky  School  of  Jledicine 4li 

Dangers  of  the  Long  Rectal  Tube..  42 

The  Best  Treatment  of  Hemorrhoids  42 


EDITORIAL. 

County  Societies  4:! 

The     Kxamination    of   Pathological 
Specimens 


Tlie  Death  Mfi  Hi  v.T  Wendell  Holmefi    AT, 


Ameri<'an  Public  Health  Association     4.'> 
T)ic   American   Electro-Therapeutic 
Association. ...    4i; 


BOOK  NOTICES. 

The  Vcar-Book  of  Treatment  for 
l>!tl4 47 

The  Retrospect  of  I'ractical  Medi- 
cine and  Surgery   .....      47 


Pamphlets  receivetl ...  47 

Class-Koom  Notes 48 

Publishers"  Department 48 


Idgfnal    (^ommiinictittons. 


^THREE  CASES  OF  CGELIOTOMY  ; 
AN  OVARIAN  CYST  ;  A  TUBAL 
PREGNANCY  ;  AND  A  H(EMA- 
TOMA  OF  THE  OVARY. 

Sy  a.  Lapthorn  Smith,  B.A.,  M.D , 
M.R.C.S.  England,  F.O.S.  London, 
Felloiv  of  the  American  Gynceco lo- 
gical Society,  Gyncecologist  to  the  Mon- 
treal Dispensary,  Surgeon  to  the  JVomen's. 
Hospital. 

Case  L  Mnltilocular  cyst  of  right  ovary. 
Removal.     Recovery. 

This  tumor  ,  which  measures  about  1 5 
inches  in  length  by  about  9  in  thickness, 
in  its  present  dried  condition  was  very 
much  larger  before  its  removal.  The 
patient,  Mrs.  T.,  from  whom  it  was  re- 
moved, was  sent  to  me  from  Valley- 
field,  on  the  4th  of  August,  the  diag- 
nosis having  been  made  by  her  physician. 
It  had  a  distinct  ovarian  expression.      An 


*  Read    before    the     Meilico-Cliinirgical     Society, 
Montreal,  2inl  November,  181>4. 


ovarian  tumor  is  often  mistaken  for  preg- 
nancy ;  but  in  this  case,  the  patient  was  led 
to  adopt  this  view  of  her  case,  more  es- 
pecially because  there  was  a  hard,  oval 
lump  in  the  right  hypochondrium  which,  I 
must  admit,  felt  very  like  a  child's  head. 
She  had  begun  to  menstruate  at  15,  nor- 
mally, was  married  at  21,  and  had  been 
mairicd  two  years  without  having  become 
pregnant,  although  she  had  skipped  a  period 
twice  since  her  marriage.  She  had  first 
noticed  her  abdomen  enlarging  sixteen 
months  ago.  On  examination,  all  the  evi- 
dences of  an  ovarian  cyst  were  found,  and 
the  uterus,  which  was  pushed  backwards 
and  to  the  left,  measured  three  inches  in 
depth.  She  entered  my  priv  ate  hospital 
on  the  1st  of  September,  and  the  tumor  was 
removed  on  the  4th,  without  any  difficulty. 
The  wound  healed  by  first  intention,  and 
she  made  such  a  rapid  and  easy  recovery, 
that  she  was  out  of  bed  in  two  weeks  and 
went  out  in  twenty-five  days.  The  other 
ovary  was  healthy,  and  was  not  removed. 
Case  IL  Tubal  Pregnancy.  Removal. 
Recovery.  The  patient  from  whom  this 
specimen  was   removed    was    Mrs.  W'.,  ict. 


26 


THE   CANADA   MEDICAL   RECORD. 


25,  married  3  )ears,  mother  of  two  children, 
last  child  one  year  ago.  She  began  to 
menstruate  at  12,  but  was  never  regular. 
She  was  married  at  22  and  became  preg- 
nant soon  after.  ShortI)'  before  the  first 
baby  was  born,  she  had  a  pain  in  her  left 
side,  which  was  thought  to  be  pleurisy, 
although  she  pointed  to  a  spot  in  the 
left  iliac  region  as  the  site  of  the  pain, 
which  leads  me  to  think  that  the  so-called 
pleurisy  was  pelvic  peritonitis, — a  belief 
which  is  strengthened  by  the  appearance 
of  old  and  dense  organized  adhesions 
between  the  ovary  and  tube  on  that  side. 
Her  first  labor  was  a  severe  one,  necessitat- 
ing the  use  of  forceps.  During  the  next 
two  years  she  had  several  attacks  of 
*'  pleurisy,"  for  which  she  was  treated  b}- 
several  different  physicians.  Every  time 
she  did  a  little  extra  work  about  her  house 
she  was  laid  up  with  an  attack,  always  in 
left  ovarian  region.  Five  weeks  before 
comii;g  under  my  notice  she  was  suddenly 
taken  with  a  very  severe  pain  in  her  left 
side  and  a  fainting  fit  while  walking  on 
the  street.  She  was  brought  home  in  a  cab. 
She  then  began  to  flow,and  continued  flow- 
ing ever  since,  rather  profusely.  She  was 
sure  it  was  not  a  miscarriage,  because  she 
had  not  missed  a  period.  After  a  few  days 
she  was  able  to  get  up  again,  but  two  weeks 
later  had  another  fainting  fit  following  a 
severe,  sharp,  cutting  pain.  Again,  the 
same  thing  occurred  one  week  before  I  saw 
her,  since  which  she  had  to  keep  to  bed 
With  the  second  and  third  attacks  she 
vomited.  She  then  called  in  a  physician 
(who  happened  to  be  one  of  my  former 
students),  who  examined  her,  and  found  a 
badly  lacerated  cervix  and  very  large  and 
tender  appendages.  He  called  me  in  con- 
sultation, when  I  found  a  mass  the  size  of  a 
small  orange  in  Douglas'  cul-de-sac,  which 
was  exceedingly  sensitive  to  pressure.  I  at 
once  diagnosed  tubal  pregnancy,  told  her 
physician  so,  and  urged  immediate  opera- 
tion.     I  based  ni}-  diagnosis  mcrel\-  on  the 


sudden  and  cutting  character  of  the  pain 
and  the  vomiting  and  fainting  in  the  street, 
coupled  with  a  continuous  flow^  during  five 
weeks.  She  entered  my  private  hospital, 
and  on  the  20th  October  I  removed  this 
beautiful  specimen.  In  order  to  make  her 
recover}-  a  satisfactory  one  in  every  respect, 
I  dilated  and  curetted  the  uterus,  and 
sewed  up  the  cervix  at  the  same  sitting, 
previous  to  the  abdominal  section  ;  and  as 
the  uterus  was  retroverted,  I  performed  ven- 
trofixation after  the  removal  of  the  appen- 
dages. The  five  ope-ations  of  dilating, 
curetting,  repairing  the  cervix,  removing 
the  appendages  and  attaching  the  uterus  to 
the  abdominal  wall,  occupied  one  hour  and 
ten  minutes.  Only  two  ounces  of  A.C.E, 
mixture  were  used.  Since  Dr.  Gordon 
Campbell  read  his  excellent  paper  on  ether, 
I  hav^e  been  following  his  example  and  have 
been  keeping  an  exact  record  of  the  quan- 
tity of  A.C.E.  mixture  used  and  the  number 
of  minutes  consumed.  I  will  have  some  sur- 
prising facts  to  lay  before  you.  For  in- 
stance, I  have  several  times  performed  from 
three  to  five  operations  with  an  expendi- 
ture of  only  one  ounce  and  a  half  of  A.C.E. 
mixture.  The  dates  of  the  various  hemorr- 
hages was  beautifully  illustrated  when  the 
specimen  was  first  removed  by  the  clots  of 
blood  surrounding  it.  There  was  rather 
bright  red  blood  recently  escaped,  dark 
and  slightly  organized  clots,  and  old,  hard 
clots  very  dense  and  firm.  When  washing 
the  specimen  the  more  recent  clots  washed 
oft'  ;  also  several  soft  clots  were  sponged 
out  of  the  abdomen,  which  was,  however, 
closed  without  irrigation  or  drainage. 

A  few  points  may  be  raised  for  discus- 
sion. Why  did  I  curette  the  uterus.'*  ist, 
Because  it  was  large  and  heavy  ;  and  2nd, 
because  I  wished  to  be  able  to  assure  you 
that  there  was  no  uterine  abortion  there. 
Why  did  I  repair  the  cervi.x  at  the  same 
sitting  .'  Because  I  have  found  it  very 
difficult  to  get  the  patient  to  go  through 
a   second    operation    if  she   has    not  been 


THE  CANADA  MEDICAL  RECORD. 


27 


cured  by  the  first.  It  is  nuicli  more  satis- 
factory to  us,  to  the  patient,  and  to  the 
good  name  of  surgery  to  do  all  that  has 
to  be  done  at  the  one  sitting,  if  they  can 
all  be  done  in  about  an  hour.  Why  did 
I  remove  the  other  ovary  ?  ist,  because 
tubal  pregnancy  never  occurs  in  healthy 
tubes  ;  and  2nd,  because  when  one  tube 
is  diseased  the  disease  nearly  always 
spreads  to  the  tube  and  ovary  ;  3rd,  be- 
cause several  cases  are  on  record  where 
one  tube  and  ovary  having  been  removed 
for  tubal  pregnancy  and  the  other  tube 
has  been  left,  the  patient  has  had  to  have 
a  second  abdominal  section  for  tubal  preg- 
nancy in  the  remaining  tube. 

This  patient  has  made  the  most  remark- 
able recovery  I  have  ever  known.  Her 
operation  took  place  at  10.30  a.m.  Satur- 
day, 20th  Oct.,  and  she  was  sitting  up  and 
dressed  at  the  same  time  the  following 
Saturday,  27th  Oct.  Next  day  she  began 
walking  about  her  room,  and  13  days  after 
the  operation  she  went  home,  walking 
down  stairs  without  help.  She  was 
carefully  watched,  but  not  only  was 
not  worse  for  getting  up  so  early,  but  is 
apparently  much  better.  She  has  her 
very  small  abdominal  incision  guarded  by 
eight  silk  worm  gut  sutures,  which  will  be 
left  in  for  four  weeks  after  the  operation. 
By  thatt  ime  the  incision  will  have  become 
united  by  non  stretchablc  material,  so 
that  there  will  be  no  hernia.  The  effect 
of  the  operation  has  been  very  satisfac- 
tory, the  pain  which  she  has  suffered  for 
several  years  having  disappeared  after  the 
operation,  and  has  not  returned.  In  fact> 
she  has  assured  me  every  day  since  that 
she  is  absolutely  free  from  pain. 

Case  III.  Hcsmatoma  of  left  ovary. 
Chronic  Salpingitis.  Removal  of  appen- 
dages. Recovery.  Mrs.  L.,  25  years  of  age, 
mother  of  one  child,  consulted  me  on  6th 
Aug.  because  she  had  never  been  well  a 
day  since  the  birth  of  her  baby,  18  months 
ago,  when  she  was  confined  to  her  bed  for 


three  months  with  milk  leg  and  fever. 
Her  labor  was  insti  umenlal,  and  seeirs  to 
have  been  a  severe  one,  for  she  has  the 
greatest  possible  dread  of  having  another 
child.  She  has  never  had  a  miscarriage. 
Her  periods  last  eight  days,  and  return 
every  three  weeks.  She  suffers  so  much 
pain  on  coitus  high  up  that  she  cannot  en- 
dure her  husband.  She  has  also  had  a 
barking  cough  for  nearly  a  year,  but  there 
are  no  physical  signs  in  the  chest. 

On  examination  there  is  found  a  deep 
bilateral  laceration  of  the  cervix,  and  upon 
the  left  side  near  the  uterus  there  is  a 
lump  about  the  size  of  a  small  orange. 
Examination  by  the  speculum  shows  the 
cervical  tissue  very  inflamed  and  of  a 
bright  red  color. 

I  treated  her  by  the  usual  means  for 
reducing  congestion  of  the  pelvic  organs 
twice  a  week  during  August,  and  up  to  the 
6th  of  September,  when  she  was  still  com- 
plaining greatly  of  the  pain  in  her  side. 
On  that  date  the  uterus  was  dilated  and 
curetted,  and  the  laceration  carefully 
repaired,  these  operations  being  followed 
at  the  same  sitting  by  coeliotomy  and  the 
removal  of  both  appendages.  The  left 
ovary  was  firmly  attached  to  the  posterior 
surface  of  the  broad  ligament,  and  on  de- 
taching it,  it  burst,  and  about  2  ozs.  of 
grumous  blood  escap-^d.  As  the  uterus  was 
in  normal  position,  though  large,  ventrofix- 
ation was  not  performed.  The  perito- 
neum and  fascia  were  closed  with  buried 
silk,  and  a  layer  of  through  and  through 
silk  worm  gut  stitches,  which  had  been 
passed  previously,  were  then  tied.  The 
patient  made  a  good  recovery,  being  up  in 
two  weeks,  and  going  home  in  a  little  over 
three  weeks.  The  silk  worm  gut  was 
left  in  for  over  four  weeks,  being  removed 
at  a  subsequent  visit  at  my  office.  In  re- 
moving the  stitches  I  take  care  to  draw 
them  up,  so  as  to  cut  a  good  distance  from 
the  knot,  thus  avoiding  stitch  hole  abscess 
by  infecting  the  track  of  the  ligature.  She 
has  had  no  return  of  the  pain  in  her  side, 
and  her  cough  has  almost  disappeared. 


28 


THE   CANADA    MEDICAL   RECORD. 


DOUBLE  FEMORAL  HERNIOTO- 
MY IN  A  WOMAN  64  YEARS  OF 
AGE  ;  PRIMARY  UNION  OF 
BOTH  WOUNDS. 

Dr.  S.  E.  Milliken,  N.Y.,  reports  a 
case  of  double  femoral  herniotomy  at 
the  advanced  age  of  64  years.  Deep 
sutures  of  kangaroo  tendon  were  used  to 
close  the  crural  canal,  while  catgut  was 
employed  for  bringing  together  the  skin 
wounds.  The  dressings  were  changed  for 
the  first  time  on  the  tenth  day,  when 
union  was  found  complete  and  the  super- 
ficial sutures  had  been  absorbed.  The 
highest  elevation  of  temperature  was  101'' 
F.,  which  occurred  within  forty-eight 
hours,  and  was  attributed  to  the  shock 
of  the  operation. 
Conclusions  : 

1.  Age  is  no  contra-indication  to  the 
employment  of  the  radical  cure  of  hernia. 

2.  Asepsis  and  antisepsis  should  be  care- 
fully observed. 

3.  Even  in  cases  of  strangulation,  the 
radical  cure  should  be  attempted,  if  the 
condition  of  the  patient  warrants  the  de- 
lay. 

4.  When  the  truss  becomes  a  source  of 
annoyance,  or  if  the  hernia  is  difficult  to 
retain,  the  operation  should  be  performed 
without  delay,  and  before  strangulation 
occurs. 

36  West  59th  Street. 


EXTRACT    OF   PRESIDENT'S    AD- 
. DRESS   BEFORE  NOVA   SCOTIA 
MEDICAL  SOCIETY,JULY,  1894.^ 
B^   C.  J.  FOX,  M.D.,   Pubnico. 

Ceiithniai : — It  is  with  extreme  diffi 
dence  1  find  m}-sclf  in  the  ])osition  I  to- 
day occupy,  and  can  only  regret  that  a 
more  representative  man  liad  not  been 
chosen.  And  yet  I  have  to  thank  you 
for  the  appointment  as  an  entirely  unex- 
pected token  of  esteem,  the  more  so    as  I 

if.  Maritime  Medical  News. 


was  unable  to  be  present  at  the  last  meet- 
ing of  the  Society.  As  the  position  is  a 
novel  one  to  me,  I  must  crave  your  gener- 
ous indulgence  if  in  an\-  respect  I  fail  to 
come  up  to  your  ideal  of  what  the  presi- 
dent of  this  honorable  body  should  be. 

It  gives  me  great  pleasure,  not  only  as 
president  of  this  Societ\-,  but  as  a  practi- 
tioner of  Yarmouth  County,  to  welcome 
all  present  at  this  the  first  meeting  of  the 
Association  in  the  western  metropolis  of 
the  province  ;  and  I  hope  it  may  arouse 
an  interest  in  the  proceedings  of  our  organ- 
ization, which,  though  I  trust  it  has  been 
felt,  it  must  be  admitted,  has  not  been 
manifested  very  largely  in  the  past  b\- 
physicians  in  this  part  of  the  province. 

Now,  while  I  have  no  right  or  desire  to 
deliver  a  lecture  to  those  who  do  not  find 
it  expedient  to  attend  the  meeting  of  this 
or  some  kindred  association,  I  have 
thought  it  might  not  be  unprofitable  to 
expend  a  few  minutes  in  considering  the 
matter  of  medical  societies  in  "general  and 
of  our  own  in  particular.  It  may  be  pro- 
perly asked  :  What  is  the  object  of  these 
societies  .•'  This  is  a  question  that  need 
hardly  be  answered  to  any  here,  and  yet  I 
fear  there  are  many  outside  the  profession 
who  have  an  erroneous  idea  of  the  purpose 
of  our  gatherings,  some  seeming  to  think 
it  a  sort  of  secret  organization  for  the  bene- 
fit of  the  profession  as  opposed  to  the 
public. 

In  answer  to  the  above  questions  as  to 
what  may  usually  be  expected  from  meet- 
ings of  this  kind,  I  think  that  the  first 
thing  that  would  suggest  itself  to  the  minds 
of  most  of  us,  and  more  especially  when 
we  glance  at  the  programmes  issued,  would 
be  a  record  of  experiences  and  a  discus- 
sion of  scientific  medical  subjects. 

Now,  while  the  exchange  of  professional 
ideas  and  the  suggestions  of  new  or  the 
improvement  in  old  methods  of  treating 
di.seased  conditions,  will  continue  to  hold 
a  primary  place  in  the  minds  of  tliose  who 


THE    CANADA    MEDICAT,    RECORD. 


29 


attend  these  meetings,  it  must  not  be  for- 
gotten that  for  many  hard-working  practi- 
tioners it  is  the  only  approach  to  a  holi- 
day they  have  from  one  year  to  another,  and 
they  require  something  besides  an  ever- 
lasting grind  of  shop  wherever  they  turn. 
The  unexpected  meeting  and  hcirty  hand- 
shake with  some  old  friend,  perhaps  a  col- 
lege chum,  out  of  sight  for  years,  will  be 
remembered  when  somebody's  disserta- 
tion on  phlegmasia  dolens  or  the  like  has 
been  long  forgotten. 

The  feeling  of  brotherhood  engendered 
will  not  be  the  least  item  to  be  placed  to 
the  credit  of  such  occasions  as  the  present. 
As  we  come  to  know  each  other  better,  it 
will  be  strange  if  there  is  not  something  to 
like  in  each  as  well  as  much  to  learn  from 
one  another.  If  you  will  allow  me,  I  will 
quote  a  passage  from  an  Address  before 
the  American  Medical  Association  some 
years  ago  by  Dr.  N.  S.  Davis,  of  Chicago  : 
"  One  of  the  best  benefits  received  at 
meetings  like  this  is  the  feeling  of  cheer- 
fulness and  pride  in  our  profession  inspired 
and  a  renewed  determination  to  make  it 
honorable,  and  meetings  of  this  kind  fur- 
nish us  each  with  that  magnetism  which 
has  more  to  do  with  curing  our  patients 
than  our  pills  and  powders." 

I  am  not  called  on  to  prove  the  neces- 
sity for  these  gatherings  ;  that  proof  lies  in 
the  prevalence  of  them.  I  cannot  say 
when  the  first  society  was  established,  but 
of  late  years  their  growth  has  been  pheno- 
menal, for  we  find  them  now  in  almost 
countless  numbers  wherever  the  art  of 
medicine  is  practised,  and  ranging  in 
magnitude,  if  not  in  importance,  from 
national  associations  down  to  county  or- 
ganizations. 

We  can  understand  this  when  we  con- 
sider that  man  is  an  animal  who  is  not  at 
his  best  in  a  state  of  isolation.  No  matter 
in  which  rank  of  the  industrial  army  he 
may  be  placed,  he  will  be  a  better  worker 
for    being  subject  to  the  attrition  of   com- 


panionship, and  this  companionship, 
with  its  attendant  advantages  of  frequent 
comparison  of  notes  and  experience,  is 
out  of  the  reach  of  a  great  majority  of  the 
practitioners  of  the  province. 

The  country  physician  who  has  no  con- 
frere within  reach  is  apt  to  get  either  care- 
less or  egotistic,  and  for  him  the  only  salv- 
ation is  to  get  out  occasionally  and  see 
and  hear  what  others  are  doing  and  how 
much  better  they  may  be  doing  it  than  he, 
though  I  do  not  by  this  intend  any  re- 
flection on  country  doctors  in  whose  ranks 
I  am  honored  in  being  placed  myself. 
The  difference  betw^een  the  town  and 
country  practitioner  was  neatly  put  by  a 
recent  writer,  in  that  the  former,  when  he 
met  a  difficult  case,  stepped  across  the 
street  and  called  in  help,  while  the  latter 
sat  down  to  think. 

Those  in  more  populous  centres  who 
are  subject  to,  in  some  cases  unfortunately 
hurried  by,  keen  competition  will  feel  the 
good  effect  of  the  relaxation  and  the  at- 
mosphere of  good  fellowship  that  as  a  rule 
pervades  these  gatherings.  We  are  pro- 
fessionally a  body  of  communists,  and 
while  we  esteem  it  as  our  duty  to  share 
with  our  fellows  that  which  falls  to  our  lot 
in  the  shape  of  new  ideas,  we  claim  as  a 
right  that  each  one  who  is  placed  in  a 
position  to  do  so  should  make  a  like  con- 
tribution as  occasion  offers,  and  it  seems 
to  me  that  no  more  fitting  medium  for 
the  mutual  exchange  could  be  devised 
than  such  gatherings  as  the  present,  where 
conclusions  drawn  and  opinions  expressed 
will  receive  that  keen  but  kindly  criticism 
which  is  more  to  be  appreciated  than  the 
calm  indifference  or  unuttered  dissent  of 
the  reading  public. 

Besides  the  social  and  scientific  func- 
tions, medical  societies  have  another  and 
important  object,  the  conservation  of  the 
legitimate  interests  of  the  profession  from 
a  legal  standpoint.  Now,  while  we  ask 
for  no  invidious  class  legislation,  we  have  a, 


30 


Tilt    CANADA    MEDICAL    RECORD. 


right  both  as  professional  men  and  as  \ 
citizens  to  be  protected  from  the  depreda-  | 
tionsofthehordeof ignorant  and  impudent  '; 
charlatans,  who  would  in  the  absence  of 
legal  prohibition  foist  themselves  upon  a 
public  who,  though  well  informed  upon 
matters  in  general,  must  of  necessity  be  at 
a  loss  in  regard  to  questions  of  a  profes- 
sional character. 

With  the  average  legislative  bodies  it 
seems  useless  to  ask  for  the  enactment  of 
any  measure  in  the  direction  of  the  eleva- 
tion of  the  professional  standing  of  physi- 
cians, unless  the  demand  is  backed  by 
some  more  potent  force  than  the  opinion 
of  isolated  individuals,  and  it  is  only  the 
united  voice  of  the  whole  profession  as 
uttered  through  their  representative  bodies 
that  will  reach  the  legislative  ear. 

In  addition  to  social,  scientific  and 
medico-legal  matters,  medical  societies 
ha\e  in  some  places  been  looked  to  to  regu- 
late aftairs  as  between  physicians  them- 
selves ;  but  as  far  as  this  province  at  least 
is  concerned,  this  is  a  function  that  has 
perhaps  wisely  been  left  largely  in  abey- 
ance. No  honorable  man  needs  a  code  of 
ethics,  and  no  dishonorable  one  will  be 
bound  by  it. 

Having  referred  to  medical  societies  in 
general,  and  their  duties  to  the  profession,  , 
I  may  say  just  iierethat  I  was  not  aware  of  | 
the  title  that  my  address  was  to  bear  until 
I  received  the  programme  of  the  meeting 
a  few  days  ago,  so  that  if  the  preamble  is 
longer  than  the  address  proper,  or  if  I  have 
appaVcntly  not  kept  very  rigidly  to  my 
text,  I  trust  you  will  bear  kindly  with  me. 
It  now  follows  in  order  to  consider  in  iiow 
far  the  Medical  Society  of  Nova  Scotia  has 
conformed  to  what  is  expected  of  such  an 
organization. 

I  have  referred  to  the  social  feature  of 
these  gatherings,  and  what  was  said  under 
that  head  applies  especially  to  these  meet- 
ings ;  they  arc,  in  fact,  what  they  were  in- 
tended to  be, — a  sort  of  family  reunion. 


Lastly,  to  what  extent  is  the  profession 
indebted  to  the  Nova  Scotia  Medical  Soc- 
iety for  legislative  measures  to  advance  the 
interests  of  those  it  represents  ^     In  reply 
to  this  I  could  not  do  better  than  refer  you 
to  the  admirable  address  of  our  then  piesi- 
dent,  Dr.  D.  A.  Campbell,  in  1889,  in  which 
he  refers  to  the  first  medical  society  of  Nova 
Scotia  in  1 854,having  been  formed  from  the 
Medical  Society  of  Halifax  as  a  nucleus.   I 
make  the  following    extract :  "  Repeated 
efforts  to  obtain  legislation  ended  in  failure. 
The  question   was  then  taken  up  by  the 
Medical  Society  of  Halifax.    A  committee 
appointed  for  the  purpose  reported  as  fol- 
lows :   'With  regard  to  the  improper  treat- 
ment of  bills  presented  of  late  years  to  the 
legislature,  your  committee  are  of  opinion 
that  the  only'alternative  now  left,  by  which 
an  effectual  resistance    may  be    offered  to 
the  unjust  procedure  of  the  committees  of 
assembly  appointed  to  investigate  the  peti- 
tions of  medical  men,  is  a  union  of  the  pro- 
fession throughout  the  province.   To  effect 
such  union,   your  committee  suggest   that 
the  Medical  Society  of  Halifax  should  be- 
come a  provincial  association    and  its  title 
altered  accordingly,  and,  further,   that  the 
practitioners    throughout  the    pro\ince  be 
invited  by  a  circular  to  become    members 
of  the  association'." 

In  1854  the  association  was  organized, 
and  the  Hon.  W.  Gregor  elected  president, 
the  country  members  having  heartily  en- 
dorsed the  scheme.  A  memorial  was  drawn 
up  for  presentation  to  legislature  and  the 
Act  of  1856  was  introduced  by  the  late 
Dr.  Webster  at  Kentville. 

It  will  not  enlarge  on  this  Act — as  the 
most  of  you  know  more  of  it  than  I  — 
further  than  to  instance  it  as  evidence  of 
what  can  be  done  b}'  united  action  under 
a  boJy  and  a  name  after  indixidual  eftbrts 
have  pioved  futile. 

Again,  where  this  Act  of  1856  was  found 
to  be  inadequate  to  the  needs  of  the  coun- 
try, and  we  were  in  clanger  of  being  flooded 


THE  CANADA  MEDICAL  RECORD. 


by  bogus  diplomas  or  overrun  by  the  liold- 
ersofnone  at  all ;  and,  further,  when  it  be- 
came a  necessity  to  take  an  advance  step 
in  order  to  keep  the  standing  of  the  pro- 
fession on  a  par  with  that  of  the  neighbor- 
ing provinces,  our  present  Medical  Society 
of  Nova  Scotia  met  the  emergency  by  the 
appointment  of  a  committee  that  drafted 
the  bill  which  afterwards  became  the  Act 
of  1872,  that  under  which  we  are  now 
working  and  which  secures  us  all  that  we 
can  reasonably  ask. 

1  may  sum  up  by  saying  that  all  the 
progressi\'e  work-  having  in  view  the  advan- 
cement of  the  interests  of  the  profession  in 
this  province  during  the  last  quarter  cen- 
tury have  emanated  directly  or  indirectly 
from  this  Society,  and  that  where  it  was 
found  necessary  to  take  steps  to  safeguard 
the  rights  secured  and  prevent  the  destruc- 
tion of  the  fabric  erected,  some  of  the  ac- 
tive members  of  the  Society  were  found  to 
the  front  successfully  battling  against  in- 
fluences that  one  time  appeared  to  seriously 
threaten  the  existence  of  the  present  Me- 
dical Act. 

I  think  enough  has  been  said  to  convince 
each  one  of  us,  who  will  consider  the  matter 
from  the  proper  standpoint,  that  this  Soc- 
iety has  claims  upon  our  loyalty,  that  we 
cannot  afford  to  disregard.  It  is  the  only 
organization  from  Cape  North  to  Cape 
Sable  that  binds  the  profession  into  one 
body,  and  yet  the  question  arises  :  Why 
out  of  nearly  four  hundred  names  on  the 
register  we  have  a  yearly  attendance  of 
from  thirty  to  forty  ?  This  I  will  not  at- 
tempt to  explain.  It  is  sufificient  to  say 
that  those  who  came  are  doubly  repaid, 
in  that  while  it -is  a  benefit  to  each  indivi- 
dually, their  presence  tends  to  exalt  the 
profession  in  the  estimation  of  the  public, 
for  the  latter  is  apt  to  honor  those  who  most 
honor  their  own. 


MONTREAL       MEDICO-CHIRURGICAL 

SOCIETY. 

Statci/  Meeting,  Sept.  2\st,  1894. 
James  Hell,  M.D.,  President  in  the  Chair. 

A  Case  of  Syinphysiotoiiiy. — Dr.  J.  C.  Came- 
ron pre.seiiied  a  rachitic  dwarf,  upon  whom  he 
had  recently  performe.i  this  operation  for  the 
relief  of  convulsions.  The  patient  was  26 
years  of  age,  height  4  ft.  6  in.  and  weighed  84 
pounds.  The  conjugate  was  6.8  cent.  Deli- 
very was  accomplished  fifteen  minutes  after 
the  cummencement  of  the  operation,  the  child 
being  alive  and  weighing  four  pounds.  The 
stitches  were  removed  on  tlie  eighth  day,  the 
union  being  perfect,  there  being  no  moving  or 
riding  of  the  bones.  The  woman  was  now 
brought  before  the  Society  for  fear  she  might 
be  lost  sight  of  after  leaving  the  hospital,  but  a 
full  report  of  the  case  will  be  given  at  a  later 
date. 

Old  Dislocation  of  the  Hip- Joint  Treated  by 
Resection. — Dr.  Bell  presented  a  little  girl 
3ged  six,  who  had  suffered  from  spontaneous 
dislocation  of  the  left  hip-joint  during  an  attack 
of  scarlatina,  and  had  been  treated  six  months 
later  by  excision  of  the  head  of  the  bone  and 
clearing  out  the  acetabulum.  She  contracted 
scarlatina  in  January,  1894,  and  was  put  to  bed 
with  her  limbs  in  a  perfectly  normal  condition. 
When  convalescent  in  the  month  of  February, 
and  without  having  met  with  any  accident  or 
presented  any  symptoms,  it  was  observed  that 
the  leg  was  deformed,  and  that  she  was  unable 
to  ."Stand  upon  it  or  to  use  it.  A  physician  was 
called  (not  the  one  who  had  diagnosed  the 
scarlatina),  who  easily  recognized  a  dislocation 
upon  the  dorsum  of  the  ileum.  Several 
attempts  at  reduction  having  failed,  she  was 
brought  to  the  Royal  Victoria  Hospital  in  July, 
where  she  was  chloroformed  and  unsuccessful 
attempts  made  at  reduction.  On  the  17th  of 
July  the  head  and  neck  of  the  bone  were 
exposed  by  incision.  One-third  of  the  globular 
head  was  worn  away  where  it  lay  upon  the 
ileum  above  the  brim  of  the  acetabulum.  The 
capsular  ligament  could  not  be  recognized 
posteriorly,  and  the  acetabulum  was  practically 
obliterated  with  fibrous  material.  There  was 
no  ligamentura  teres.  The  limb  could  not  be 
sufficiently  extended  to  replace  the  head  in  the 
acetabulum  and  extend  the  limb.  The  muscti- 
lar  resistance  seemed  to  be  general.  (There 
was  i^  inches  of  shortening  with  the  limb 
brougiit  down  as  well  as  possible.)  There  was 
no  sign  of  inflammatory  or  other  pathological 
change.  The  head  of  the  bone  was  excised 
and  the  acetabulum  cleared  out,  when  the  limb 


32 


THE    CANADA    MEDICAL    RECORD. 


fell  easily  into  position.  Tlie  patient  made  an 
uninterrupted  recovery,  the  wound  healing  by 
first  intention.  The  limbs  remain  in  normal 
position.  She  has  free  movement  in  every 
direction  and  a  good  strony,  iin.b,  and  there  is 
half  an  inch  of  shortening,  although  from  the 
tilting  of  the  pelvis    it  seems  greater. 

Rcsirtio>i  of  the  Intestines. — Dr.  Shephkrd 
exhibited  two  cases  in  which  he  had  resected 
the  bowel. 

Case  I. This  case  was  shown  to  the  Society 

soon  after  operation  three  years  ago,  and  she 
was  now  ngain  brought  before  the  Society  in 
order  to  show  in  what  a  good  condition  she  was. 
The  resection  was  for  stenosis  following  stran- 
gulated hernia,  for  which  operation  had  been 
peiformed.  At  the  time  of  operation  the  gut 
had  looked  suspicious,  but  was  returned  ;  more 
sloughing  occurred,  and  this  was  followed  by 
the  stenosis  for  which  resection  was  performed. 
Several  inches  of  the  bowel  had  been  removed, 
and  the  cut  ends  sutured  end  to  end  by  an  inner 
row  of  interrupted  silk  sutures  passing  through 
muscular  and  mucous  coats  and  an  outer  row 
of  Tembert's  sutures  through  the  serous  coat. 
The  patient  recovered  well,  and  when  shown 
appeared  in  good  health.     Her  age  is  56. 

Case  II. — This  was  a  case  of  resection  of 
nine  inches  of  small  bowel  in  a  woman  aged 
40.  The  bowel  had  l)een  strangulated  for  five 
days,  and  was  found  gangrenous  at  the  operation 
for  the  relief  of  the  strangulation.  As  the 
patient's  condition  was  fairly  good,  imiriediale 
resection  was  performed.  The  cut  ends  of  the 
bowel  were  sutured  by  two  rows  of  continuous 
sutures,  the  inner  row  passing  through  the 
mucous  membrane  and  nnucular  coat,  and  the 
outer,  a  continuous  Lembert,  through  the 
serous  coal.  The  hernia  was  an  inguinal  one, 
and  after  suturing  the  bowel  a  radical  cure  was 
performed  by  excising  the  sac  and  obliterating 
the  inguinal  canal.  The  patient  got  well  with- 
out a  bad  symjnom,  and  the  bowels  moved 
naturally  on  the  fifth  day.  She  went  out  in 
four  weeks  perfectly  well.  It  was  now  six 
weeks  since  the  operation.  Dr.  Shepheid 
remarked  that  it  was  now  his  custom  to  use 
the  continuoossulure,  and  that  he  usedno  plates 
or.other  apparatus.  The  suturing  of  tiic  bowel 
did  not  take  very  long,  some  twenty  minutes.  It 
was  his  experience  that  the  divided  mesentery 
gave  most  trouble  on  account  of  the  hemorr- 
hage and  its  liability  to  tear.  He  was  strongly 
of  opinion  that  immediate  resection  was  the 
best  treatment  in  all  cases  of  gangrenous  hernia 
where  the  condition  of  the  patient  was  good  ; 
in  other  cases  it  would  be  the  better  treatment 
to  open  the  bowel  and  form  an  artificial  anus, 
which  could  be  closed  by  a  subsequent  opera 
lion. 

A  Case  of  Pylorectomy. —  Dr.  .Ahmsirdng 
exhibited  a  woman  from  whom  he  had  recently 
ex(  ised  the  jiylorus,     She  came  to  the  Montreal 


General  Hospital  on  the  loth  of  May,  1894' 
complaining  of  a  tumor  situated  in  the  right 
liypogastrium  just  below  the  f-eventh,  eighth  and 
ninth  ribs,  associated  with  pain  and  nausea 
after  ea'.ing.  Wishing  to  gain  some  accurate 
knowledge  of  her  gastric  condition,  Dr.  Arm- 
strong sent  her  to  the  medical  wards  under  the 
care  of  Dr.  I.afleur,  who  made  the  necessary 
investigations. 

Dr.   Lafleur  had  first  seen   the  ])atient    in 
the  out-door  department,  and  under  the  impres- 
sion that  it  was  a  case  of  malignant  growth    of 
the  pyloric  extremity  of  the  stomach  and  of  a 
kind  suitable  for  operation,  he  sent  her  upstairs 
to  Dr.  Armstrong,    who  confirmed  this    view, 
but  returned  her  to  the  medical  department  for 
further  infoimaiion  as    to  the  functions   of  her 
stomach.       Her  history    was    as    follows  :     In 
December,  1893,  she    began  first  to  feel  out  of 
sorts,  without,   however,  any  definite  stomach 
symptoms.     In  January,    1894,  there  was  pain 
in  the  epifaslrium  after  eating.     February.  1894, 
the  ].>ain  persisted,  but   was    regularly  relieved 
by  an  attack  of  vomiting  coming  on  after   two 
hours  after  eating.     She    grew  slowly    weaker, 
and  by  the  end  of  the  month  had  to  take  to  bed. 
These  conditions  persisted  during  the  following 
March  and  April,  accompanied  by  a  steadily 
])rogrtssive  loss  of  flesh      She  lost  37  pounds 
from  the  beginning  of  her  illness  until  the  date 
of  her  appearance  at  the    out-dogr  department 
of  the  hospital.     She  was  a  dark  woman,  much 
emaciated,  but  with  her  muscles  still  in  fairly 
good  condition.    Examination  of  the  respiratory, 
circulatory  and  urinary  systeins  proved  negative. 
The  digestive  symptoms  were    poor  appetite, 
bad  taste  in  the    mouth,    constipation,  pain    in 
the  stomach  and  vomiting  after  meals.     Ph)si- 
cal  signs  as  detected  under  examination  in  the 
wajd  were  enlargement  of  the   stomach  ascer- 
tained   by    means     of    the    peristaltic     waves 
observed  to    tiaverse  from  left  to    right.     The 
boundaries  were  above,    extending   on  a   line 
with  the  ninth  costal  cartilages    on  both  sides, 
ai.d  below,   reaching  as   far  as   the  umbilicus, 
typical  hourglass  contractions  of   the  stomach 
were  at  limes  noticed.     There  was  a  h^rd  tumor 
about  the  size  of  a  hen's  egg,  movable  in  every 
direction  except  downwards,  and  varying  greatly 
in  its  situation.     No  contractions  could  be  ob- 
served in  this  tumor,  and  percussion  gave  a  dull 
note.     It  wa«  continuous  with  the  funnel-shaped 
outline    of  the     stomach.     No   nodules    were 
observed.     On    May    19th     a    test    bn  akfast, 
consisting  of  a  small  piece  of  bread  and  a  cup 
of  lea  without   milk  or  sugar,  was  given,  and 
withdrawn  one  hour  afterwards.     The  examina- 
tion of  its  contents  revealed  a  complete  absence 
of   free    hydrochloric   acid,    the    gastric   juice 
seemed  effective,  but  lacked  the  presence  of  the 
acid.      'J  he    want   of   this     latter    constituent 
seemed  to   be   the  chief  abnormal    feature.     A 
few  days  later  a  second  meal  was  administered. 


THE  CANADA  MEDICAL  RECORD. 


33 


which  confirmed  in  every  way  the  first.  From 
a  medical  standpoint  the  chief  interest  in  ihe 
case  was  the  probability  of  its  proving  a  suit- 
able one  for  operation,  owing  to  the  complete 
absence  of  adhesions,  as  evidenced  by  the 
extreme  mobility  of  the  tumor  and  absence  of 
all  indication  of  involvement  of  the  lymphatic 
glands.  The  rule  that  abdominal  tumors  are 
always  larger  when  exposed  than  tliey  a|  pear 
from  external  examination  was  contradicted  in 
this  case.  There  was  no  appreciable  difference 
between  its  real  size  and  that  which  we  supposed 
it  to  be  before  opening  the  abdomen. 

Dr.  Armstrong  said  that  the  patient  having 
returned  to  the  surgical  ward,  the  question  of 
surgical  interference  with  all  its  attendant 
dangers  was  put  before  her  to  decide.  So 
miserable  was  her  condition  that  she  preferred 
death  to  a  continuance  of  life  under  such  cir- 
cumstances, and  gladly  chose  the  risks  of  an 
operation.  Before  anassthetizing  her,  a  hypoder- 
mic of  morphia  and  atropia  was  administered, 
with  a  view  to  le->sen  the  shock  of  tlie  anaes- 
thetic, and  it  had  very  satisfectoiy  results.  She 
took  the  ether  quietly,  there  was  no  vomiting, 
and  only  63^2  ounces  were  used  in  the  two  hours 
she  was  under  its  influence.  Her  pulse,  which 
was  100  at  the  start,  fell  to  70  before  she  left 
the  table.  A  median  incision  was  made,  and 
the  tumor  brought  up  to  the  opening.  It  was 
small  and  well  defined,  quite  movable,  n  ni  ad- 
herent to  surrounding  organs,  and  there  seemed 
to  be  no  infiltration  or  involvement  of  any  of 
the  surrounding  parts.  It  seemed  a  very  suit- 
able case  for  removal  of  the  growth.  The 
greater  and  lesser  omenta  were  tied  off,  the 
pylorus  drawn  well  up,  and  the  duodenum  con- 
stricted by  a  soft  rubber  band  at  a  point  about 
2j^  inches  from  the  pylorus.  An  incision  was 
then  made  across  the  stomach  well  above  the 
tumor,  taking  care  to  have  it  include  all  infil- 
trated tissue ;  and  the  duodenum  was  then  cut 
across  well  below  the  tumor.  A  hole  was  then 
made  in  the  posterior  wall  of  the  stomach  and 
the  duodenum  united  here,  instead  of  the  usual 
method  of  joining  it  to  the  head  of  the  organ. 
In  this  way  he  was  enabled  to  work  right  inside 
the  stomach  in  the  process  of  uniting  the  duo- 
denum, which  obviated  many  of  the  mechanical 
difficulties,  and  after  joining  it  from  the  inside, 
the  stomach  was  turned  over  and  the  parts 
further  united  on  the  outside  by  a  Lembert 
stiture.  The  end  of  the  stomach  itself  was  then 
closed  up,  the  edges  being  inverted,  united,  and 
the  serous  coats  being  finally  joined  by  two 
rows  of  Lembert' s  sutures.  Her  recovery  was 
as  smooth  as  possible,  there  being  neither  pain 
\  nor  vomiting.  Solid  food  was  first  administered 
on  the  fifth  day,  and  she  has  been  taking  it  ever 
I  since.  She  was  last  weighed  about  two  months 
'  ago,  and  had  then  gained  ten  pounds,  and  has 
I  been  increasing  in  weight  ever  since.  She 
(.looks  well  nourished,  and  says  her  appetite  is 
sood. 


Dr.  Shepherd  congratulated  Dr.  Armstrong 
on  the  success  of  this  extraordinary  operation. 
It  was,  so  far  as  he  knew,  the  first  of  the  kind 
ever  performed  in  Canada,  and  was,  without 
doubt,  the  first  in  Montreal.  He  had  seen  the 
paiient  after  the  operation,  and  looking  at  her 
now  he  must  say  he  had  never  seen  a  case  do 
better,  which,  when  we  consider  the  seriousness 
of  the  condition,  is  saying  a  great  denl.  He 
thought  much  of  tli';  rapid  improvement  may 
be  attributed  to  the  early  feeding,  as,  in  his 
opinion,  the  patients  in  many  of  the  older  cases 
owed  their  deaths  to  the  starvation  which  was 
enforced.  Dr.  Armstrong's  procedure  in  bring- 
ing the  duodenum  through  a  separate  opening 
into  the  stomach  is  regarded  as  the  only  [)roper 
me  hod  by  European  surgeons. 

Dr.  Roddick  joined  with  Dr.  Shepherd  in 
congratulating  Dr.  Armstrong  on  his  success 
in  this  case.  Early  feeding,  without  a  doubt, 
contributes  largely  to  the  success  of  these  cases. 

Dr.  James  Bell  said  that  the  trouble  with 
these  cases  is  the  fact  that  most  of  them  only 
submit  to  operatioti  when  they  are  praciicilly 
moribund,  and  when  the  disease  has  conse- 
quently made  such  progress  as  to  render  a  cure 
under  any  circumstances  almost  hopeless.  He 
had  more  than  once  opened  the  abdomen  in 
cases  of  this  kind,  only  to  find  the  disease  so 
advanced  that,  unless  for  the  relief  ofa  stricture 
or  some  such  mechanical  difficulty,  an  operation 
was  unwarrantable. 

An  Appendix  containing  an  Ordinary  Pin 
as  the  Exciting  Cause  of  a  Perforating  Appen- 
dicitis.— Dr.  Bell  presented  the  specimen,  and 
gave  history.  The  patient,  a  boy,  aged  six, 
had  been  brought  to  the  Royal  Victoria  Hospi- 
tal with  the  usual  symptoms  and  signs  of 
appendicitis  with  abscess  formation.  There 
was  a  history  of  two  days  illness.  The  child 
was  operated  upon,  and  made  a  good  recovery. 
On  slitting  up  the  appendix  a  pin  was  found 
lying  transversely  across  its  lumen  near  the 
apex.  The  head  ot  the  pin  had  perforated 
(by  ulceration)  all  the  structures  of  the  appen- 
dix, and  the  point  of  the  pin  had  very  nearly 
perforated  at  the  opposite  side,  and  at  this 
point  the  appendix  was  strengthened  by  a  mass 
of  adherent  omentum.  This  was  the  only  case 
which  Dr.  Bell  had  seen  with  an  actual  foreign 
body  as  the  exciting  cause  of  the  disease — except 
possibly  a  foreign  body  may  have  been  the 
starting  point  of  some  of  the  enteroliths  so 
frequently  found  in  the  appendix. 

Calcareous  Tumor  of  the  Thyroid  pt  oduc- 
ing  CEsephageal  Obstruction. — Dr.  Bell 
showed  the  specimen  and  reported  the  case. 
An  old  lady,  aged  58,  had  suffered  for  two  years 
and  a  half  from  difticulty  in  swallowing,  gradu- 
ally growing  worse,  until  she  was  actually 
starving.  Since  March  last  she  had  not  been 
able  to  swallow  solids  at  all,  and  liquids  otily  in 
very  small  quantities,   and    with   the   greatest 


34 


THE  CANADA  MEDICAL  RECORD. 


difficulty.  She  wa3  greatly  emaciated  and  very 
weak.  She  was  shoit  of  breath  on  excitatif)n, 
and  also  had  one  or  two  severe  attacks  of 
dyspnoea.  A  small,  hard  nodule  was  felt  ab(wc 
the  right  sterno  clavicular  articulation,  ar.d  i^he 
stated  that  she  had  suffered  from  goitre  when  a 
young  girl,  but  that  it  had  gradually  disappeared. 
The  diagnosis  was  substernal  calcareous  thyioid 
tumor,  and  operation  advised.  Enucleation 
was  not  difficult  and  not  attended  with  haemorr- 
hage, the  patient  made  a  rapid  recovery,  and  is 
now  swallowing  quite  well.  The  tumor,  which 
was  about  the  size  of  a  hen's  egg,  was  conical 
in  shape  and  flattened  against  the  sterum  a  id 
sternal  end  of  the  clavicle.  The  apex  liad 
apparently  pressed  against  the  oesophagus.  In 
structure  it  resembled  one  of  the  tarsal  bo  :es 
(excepting  the  articular  surface),  having  a 
smooth  outer  surface  resembling  compact  bcny 
tissues,  and  cancellated  structures  internally. 
The  operation  was  performed  on  the  i3tii  of 
August  last. 

Tumor  of  the  Frostatc. — Two  specimens 
were  presented  by  Dr.  Bell,  and  brief  histoiies 
given.  I'he  first  was  from  a  man  aged  58,  ^^  ho 
had  suffered  for  ten  years,  with  symptoms  of 
prostatic  obstruction.  For  the  first  six  years  he 
had  suffered  greatly,  and  in  March  last  he  had 
had  a  large  calculus  removed  by  lateral  litho- 
tomy, which  gave  a  measure  of  relief,  but  tiiis 
was  only  temporary.  On  examination,  sevcial 
stones  were  found  in  the  bladder,  and  supia- 
pubic  section  was  advised  for  the  removal  of 
the  ca)culi,  and  subsequent  prostatectomy  if 
thought  necessary  or  desirable.  On  section,  five 
(5)  smallish  stones  were  removed  and  the  pro- 
jecting prostate  enucleated.  Several  deep 
sloughy  ulcers  were  found,  apparently  due  to 
the  pressure  of  ihe  calculi,  and  prostaiectomy 
was  decided  upon.  Only  the  projecting  part 
of  the  prostate  was  removed  by  enucleation, 
and  the  patient  made  an  excellent  recovery. 
He  is  now  perfectly  well,  has  good  bladder 
function  (although  there  is  some  residual  urine), 
and  is  quite  free  from  pain  and  frequent  desire 
to  micturate. 

The  second  case  was  an  old,  decrepit  man  of  j 
68,  who  had  suffered  for  a  great  many  years,  J 
buf  for  the  past  year  his  sufferings  had  been  so 
great  that  he  declared  that  life  was  intolerable 
unless  he  could  be  relieved.  His  urine  showed 
no  evidence  of  kidney  disease,  and  after  due 
preparation  the  prostate  was  enucleated  by  the 
suprapubic  route.  The  points  of  interest  were 
the  great  ease  with  which  the  bladder  gland 
was  enucleated  in  its  entirely  (making  an 
unique  specimen)  very  rapidly,  ajid  without 
hemorrhage  or  shock.  On  the  third  day  the 
patient  began  to  grow  dull  and  stupid,  and  died 
on  the  fourth  day  toxiiemic.  .At  the  autopsy  a 
few  spots  of  very  recent  lobular  pneumonia 
were  found  in  the  left  lung,  but  the  organs  were 
otherwise    healthy.      The    bladder    was    also 


presented,  showing  the  capsule  from  which  the 
prostate  had  been  removed.  Urine  had  flowed 
freely  from  the  bladder  wound,  showing  that 
there  was  no  arrest  of  kidney  function.  In 
both  these  cases  the  after-treairnrnt  consisted 
in  irrigation  every  three  hours  with  boro-salicy- 
lic  solution  through  a  catheter  introduced  into 
the  bladder  by  the  penis,  the  outflow  being 
through  the  bladder  wound.  Dr.  Bell  expressed 
the  opinion  that  the  operation  of  the  future  would 
be  enucleation  from  the  perineal  side,  and  that 
this  could  best  be  carried  out  by  means  of 
combined  supra-pubic  and  jierineal    incisions. 

Dr.  Shepherd  had  a  somewhat  similar  case 
to  the  first  within  the  past  few  months,  A  man 
came  from  the  country  who  had  been  sounded 
many  times  for  stone  without  success.  Dr. 
Shei)herd  was  also  unsuccessful  until  he  exam- 
ined him  under  ether.  There  was  no  sensible 
enlargement  of  the  prostate.  A  supra-pubic 
section  was  made,  and  two  very  rough  stones 
were  found  lying  in  the  bladder.  Wherever 
they  had  come  in  contact  with  the  bladder  wall 
a  sloughing  ulceration  had  taken  place.  He 
treated  the  ulcers  with  caustic  without  interfer- 
ing further  with  the  prostate.  This  was  the 
first  time  that  he  had  ever  seen  such  a  condi- 
tion of  the  bladder  in  connection  with  stone  ; 
but  it  may  be  that  they  are  more  frequent  than 
we  think,  as  it  is  not  possible  to  see  them  during 
the    lateral  operation,  even  when  looked   for. 

Dr.  Roddick  believed  in  removing  the  pros- 
tate by  a  perineal  opening.  He  had  removed 
diseased  glands  on  two  or  three  occasions  by 
this  method,  and  was  surprised  how  easy  it  was 
to  shell  them  out.  He  had  no  doubt  that  it 
would  in  time  become  the  standard  method  of 
removing  the  prostate. 

Dr.  Armstrong  had  recently  seen  Prof.  Mc- 
Keown,  of  Glasgow,  remove  a  prostate,  and 
had  a  talk  with  him  on  the  subject  afterwards. 
Some  time  after  the  Leeds  meeting  of  the 
British  Medical  Association  the  professor  had 
discarded  the  perineal  method  and  adopted  the 
supra-pubic,  as  there  advised.  His  results, 
however,  were  exceedingly  bad.  One  after  an- 
other of  his  patients  died  of  toxaemia  and  he- 
morrhage, until  he  finally  went  back  to  the 
perineal  method,  which  plan  he  now  almost 
without  exception  adopts.  Sometimes  when 
only  one  lobe  is  enlarged,  he  will  remove  it 
through  a  lateral  incision.  In  the  perineum, 
he  exposes  the  prostate  by  a  U-shapecl  incision, 
and  enucleates  it  without  opening  the  mucous 
membrane  of  the  bladder.  In  this  way  he 
avoids  toxic  troubles  and  can  control  haemorr- 
hage by  jjacking.  It  seems  very  desirable  that 
we  should  get  some  better  metho  1  in  prostate 
surgery  than  the  sujjra  j^ubic  one,  and  we 
would  then  be  in  a  position  to  relieve  a  large 
class  of  peoi)le  who  now  sufter  from  prostate 
disease  in  its  last  stage. 

Dr.  Bell  often  supplemented  his  supra-pubic 


THE   CANADyV    MEDICAI,   RECORD. 


35 


incisions  by  a  perineal  drain.  This  in  many 
instances  did  not  appear  to  cause  any  improve- 
ment in  the  results,  and  he  found  it  hard  in 
believe  that  the  difference  between  the  iwo 
methods  can  be  so  very  great.  Again,  it  is  often 
very  difficult  to  enucleate  by  the  peiineal 
method  without  injuring  the  mucous  membrane 
of  the  bladder  over  the  prostate.  His  idea  of 
late  has  been  a  double  incision — supra-pubic 
and  perineal — so  that  instead  of  enucleating 
from  the  bladder  only,  one  could  enucleate 
from  the  perineum  with  the  fingers  in  the 
bladder  as  an  aid  and  guide  to  the  perform- 
ance. 

Four  Calculi  zveighing  5  ou/iccs  i  drachm 
removed  Jrom  the  Bladder. — Dr.  Roddick 
exhibited  four  remarkable  calculi,  removed 
from  a  man,  65  years  of  age,  who  had  been  for 
four  or  five  years  suffering  from  bladder  symp- 
toms. During  that  lime  he  had  been  several 
times  sounded  for  stone,  the  last  occasion  being 
not  more  than  three  months  ago,  but  without 
any  signs  of  such  a  condition  ever  being  detec- 
ted. Enlarged  prostate  with  symptoms  arising 
therefrom  was  looked  upon  as  his  disease. 
Dr,  Roddick,  on  examination,  succeeded  in 
diagnosing  the  presence  of  a  fairly  large  stone, 
the  size  of  which,  in  fact,  made  him  conclude  it 
was  the  only  one.  The  existence  of  an  enlarged 
prostate,  and  the  unhealthy  condition  of  the 
bladder,  decided  him  to  choose  the  supra-pubic 
method.  On  making  his  incision,  a  large  stone 
presented  in  the  wound,  which  on  being  re- 
moved was  succeeded  by  another,  and  so  <  n 
until  four  large  ones  were  removed,  weighing 
in  the  order  of  their  size  37,  38,  39  and  50 
grammes  respectively.  Two  of  them  must  cer- 
tainy  be  looked  upon  as  very  large,  and  con- 
sidering the  combined  size,  as  well  as  the  circum- 
stances of  the  history,  the  case  is  altogether  a 
very  remarkable  one.  The  failure  of  the  previous 
surgeons  to  detect  stone  by  sounding  is  ex- 
plained by  the  fact  that  the  calculi  were  all  ly- 
ing in  a  distinct  sac,  or  pocket  of  the  bladder ; 
the  examinations  no  doubt  were  made  with  the 
bladder  empty,  and  its  mucous  membrane  fold- 
ing itself  over  the  stones  deadened  the  touch 
of  the  sound. 

Cases  of  Cholecystotomy. — Dr.  Shepherd 
reporte'd  two  cases  performed  during  the  last 
six  weeks.  In  the  first  case  the  patient  was  a 
woman,  and  aged  36  years.  For  two  years  she 
had  suffered  much  pain  about  the  right  hypo- 
chondriac region,  the  first  attack  of  pain  being 
accompanied  by  profuse  jaundice,  which  lasted 
several  months  and  then  disappeared.  There 
was  always  a  pain  of  a  dull  character  in  the 
region  of  the  gall  bladder.  In  February  last 
she  had  a  severe  attack  of  pain,  high  tempera- 
ture, rigors,  and  rapidly  became  jaundiced.  In 
July,  she  noticed  a  tumor  to  the  right  of  the 
umbilicus  ;  it  was  painful,  and  seemed  to  in- 
crease slowly    in  size  up  to  the  time  of  her  en- 


trance into  the  hospital.  All  this  time  she  was 
deeply  j.umdiced,  her  urine  was  dark  in  color 
and  her  stools  were  colorless.  On  examining 
her,  it  was  noticed  that  she  was  veiy  thin  and 
deeply  jaundiced.  She  comi:)laincd  of  dull, 
aching  pain  in  the  right  hypochondrium  ;  h  d 
continuous  nausea,  was  feverish  at  night  and 
often  suffered  from  chills.  On  examining  her 
ab  lomcn,  a  round  smooth  tumor  vvas  felt  to  the 
right  and  below  the  umbilicus;  this  was  dull 
on  peicussion,  the  dullness  being  c(jntinuous 
with  that  of  the  liver.  The  tumor  was  about 
the  size  of  a  small  cocoa-nut,  elastic  and  freely 
movable.  Dr.  Lafleur  examined  the  case,  and 
looked  upon  it  as  a  case  of  enlarged  gall-blad- 
der. The  operation  was  performed  on  August 
30th,  and  the  tumor  was  found  to  be  a  largely 
distended  gall-bladder  projecting  beyond  a 
'•  lacing  lobe"  of  the  liver;  it  was  opened,  and 
about  a  pint  of  thick  bile  evacuated.  A  few 
small  stones  were  found  in  the  gall-bladder,  but 
the  cystic  duct  was  not  dilated.  On  examining 
further,  two  larg^  stones  were  found  in  the 
common  duct,  and  these  were  soft,  and  could 
not  be  broken  up  by  needle  or  padded  forceps, 
so  ihe  gall-bladder  was  sutured  to  the  abdom- 
inal wound  and  a  glass  drain  inserted.  Patient 
has  gone  on  perfectly  well  ever  since,  large 
quantities  of  bile  being  discharged  through  the 
tube  into  a  rubber  bag  which  is  attached  to  it. 
The  patient  is  up  and  about,  and  eats  well. 
The  jaundice  has  almost  disappeared,  but  un- 
less something  more  be  done,  she  will  have  a 
permanent  fistula  discharging  bile.  Dr,  Shep- 
herd said  that  if  the  fistula  persisted,  it  was  his 
intention  to  do  a  further  operation,  viz.,  to  re- 
open the  wound  and  perform  a  cholecystenter- 
ostomy,  and  then  close  the  present  opening  in 
the  gall-bladder.  In  making  a  communication 
between  the  gall-bladder  and  intesti  le,  it  was 
his  intention  to  make  use  of  the  Murphy  button. 
In  the  second  case  there  had  been  severe 
attacks  of  pain  with  jaundice  and  high  temper- 
ature for  more  than  a  year.  The  patient  was 
a  woman ,  aged  36,  who  was  somewhat  stout. 
Dr.  Shepherd  saw  her  in  the  last  attack,  and 
advised  her  removal  to  hospital.  She  had  a 
temperature  of  103°— 4°,  with  great  tenderness 
and  pain  in  right  hypochondrium,  and  she  was 
intensely  jaundiced.  She  improved  immedi- 
ately on  admission  to  hospital,  the  jaundice 
rapidly  disappearing.  No  stones  were  found 
in  her  stools.  Although  the  pain  had  disap- 
peared, there  was  a  point  of  great  tenderness  in 
the  region  of  the  gall-bladder.  At  her  request 
operation  was  performed  on  September  7th,  to 
prevent  further  attacks.  An  incision  was  made 
in  the  left  semilunar  line  and  the  gall-bladder 
searched  for;  it  vvas  hidden  by  adhesions,  and 
situated  deeply  down  beneath  a  high -placed 
liver.  On  opening  it,  a  small  quantity  of  bile 
escaped,  and  six  gall-stones  the  size  of  marbles 
were  removed ;     the   common  duct   was  free. 


THE   CANADA   ^lEDICAL   RECORD. 


Tlie  gall-bladder  could  not  be  brought  up  lo 
the  surface,  so  a  glass  drain  was    introduced 

and  the  cavity  packed  round  with  iodoform 
gauze.  The  wound  was  closed  l)y  three  layers 
of  sutures.     The   patient  went    on  very  well. 

I'he gauze  was  removed  onthe second  day,  and 

replaced,  but  a  day  or  two  after  a  severe  iodo- 
form rash  appeared,  so  the  sterilized  gauze  was 
substituted  for  the  iodoform.  The  tube  was 
removed  on  the  tenth  day,  the  amount  of  bile 
coming  away  having  very  much  diminished. 
She  is  now  going  on  well,  sitting  up  and  going 
out.  The  fistula  is  ra])idly  closing,  a  very 
small  quantity  of  bile  being  now  discharged. 
Dr.  Bell  also  reported  a  case  of  obstructive 
jaundice  in  which  the  symptoms  pointed  to 
obstruction  in  the  common  duct.  A  woman 
aged  50  had  suffered  from  pain  and  disturbance 
about  the  right  hypochondrium  for  about  eigh^ 
months.  Since  March  last  she  had  suffered 
from  paroxysmal  attacks  of  pain  with  some 
vomiting  followed  by  jaundice,  which,  although 
diminishing  in  the  intervals,  never  entirely  dis- 
appeared. Later  on  she  had  chills,  and  the 
jaundice  became  persistent,  increasing  with 
each  attack. 

Diagnosis. — Obstruction  in  common  bile  duct 
from  gall-stone,  or  possibly  malignant  disease. 
Operation  July  23/7/. — Incision  in  right  linea 
semi  lunaris.  Firm,  old  adhesions'made  it  very 
difficult  to  expose  the  under  surface  of  the  liver, 
so  that  it  became  necessary  to  make  a  trans- 
verse incision  from  the  upper  extremity  of  the 
vertical  one  inwards  nearly  to  the  niedim  line. 
The  liver  was  shrunken  and  retracted  beneath 
the  ribs.  The  gall-bladder  contained  no  fluid, 
and  was  contracted  upon  a  stone  which  lay  in 
the  entrance  to  the  cystic  duct,  and  was  as  large 
as  a  filbert.  Nothing  could  be  detected  in  the 
common  duct,  but  a  chain  of  enlarged  lympha- 
tic glands  were  felt  in  the  hepatic  fissure.  The 
gall-bladder  was  incised  and  the  stone  removed. 
A  probe  forced  down  the  duct  failed  to  enter 
the  bowel.  He  did  not  feel  that  he  had  re- 
moved the  cause  of  the  trouble,  but  being  un- 
able to  locate  any  obstruction  elsewhere  in  the 
biliary  passages  he  could  do  nothing  further. 
As  it  was  utterly  impossible  to  suture  the  wound 
ill  the  gall-bladder,  which  lay  far  back  and 
high  up  underneath  the  ribs,  to  the  peritoneum 
lining  the  abdominal  walls,  or  in  any  other  way 
establish  a  natural  conduit  for  the  outflow  of 
bile,  the  wound  was  closed  with  sutures,  the 
ends  of  which  were  brought  up  through  the 
ab<iominal  wall  to  fix  it  in  position.  Although 
there  was  no  flow  of  bile  during  the  operation, 
it  was  not  thought  probable  that  the  wound  in 
the  gall-bladder  would  remain  closed,  especially 
as  it  was  impossible  to  apply  Lenibert  sutures, 
owing  to  the  fragility  of  its  peritoneal  covering. 
A  glass  drain  was  carried  down  to  the  line  of 
sutures  in  the  gall-bladder,  and  carefully  packed 
around  with  iodoform   gauze — the  idea  being 


that  the  sutures  would  probably  keep  the  gall- 
bladder closed  for  a  couple  of  days  until  the 
track  of  the  drainage  tube  would  become  closed 
off  from  the  general  peritoneal  cavity  by  adhe- 
sions. This  was  evidently  successful,  as  there 
was  no  biliary  discharge  from  the  lube  for  five 
days,  when  bile  began  to  flow  in  great  quanti- 
ties. The  jaundice  then  began  to  disapi^ear, 
but  the  stools  remained  colorless  and  covered 
with  oil  globules.  Bile  continued  to  flow  in 
large  quantities  until  the  12th  of  August  (20 
days  after  operation),  when  it  rapidly  dimin 
ished  and  the  stools  became  normal  in  color. 
Nine  days  later  (August  21st)  the  wound  was 
perfectly  healed,  the  jaimdice  gone  and  the 
digestive  functions  normal,  and  the  patient  was 
discharged. 

The  post-operative  history  of  this  patient,  I 
think,  supplies  the  missing  link  in  the  diagnosis. 
When  we  remember  that  the  gall-bladder  was 
empty  at  the  time  of  operation,  that  there  was 
a  chain  of  swollen  lymphatic  glands  along  the 
line  of  the  hepatic  duct,  that  bile  began  to  flow 
from  the  wound  five  days  after  operation,  and 
that  it  ceased  to  flow  thiou^h  the  wound  and 
began  to  flow  through  the  common  duct  20 
days  after  operation,  it  seems  pretty  clear  that 
obstruction  was  due  to  pressure  from  the  en- 
larged glands  from  without,  and  that  when  the 
exciting  cause  was  removed  and  the  swelling 
disappeared  from  the  glands,  the  symptoms  all 
subsided.  Dr.  Bell  knew  of  no  similar  case 
recorded. 

Dr.  Roddick,  in  April,  1892,  had  a  case  of 
cholecystotomy  which  he  thought  worthy  of  re- 
cording, especially  so,  since  he  was  under  the 
impression  it  was  the  first  operi.tion  of  the  kind 
ever  performed  \\\  Montreal.  A  lady,  64 years  of 
age,  had  beenj  undiced  for  nearly  one  year, 
accompanied  by  pain,  etc.,  and  her  symptoms 
had  gradually  become  much  worse.  Examina- 
tion revealed  a  distinct  tumor,  which  had  all  the 
signs  of  being  a  distended  gall-bladder.  An 
incision  confirmed  this  fact,  an  enormously 
distended  gall-bladder  being  found,  containing 
about  one  pint  of  thick  treacly-looking  bile. 
A  conical-shaped  stone,  about  the  size  of  a 
filbert,  was  found  blocking  the  cystic  duct  ; 
and  along  the  line  of  the  common  duct  a 
distinct  thickening  was  felt,  but  whether  of  a 
simjjle  or  malignant  character  could  not  be 
ascertained.  The  size  of  the  gall-bladder  made 
it  an  easy  matter  to  bring  it  up  to  the  abdom- 
inal wgund  and  suture  it  there,  a  drainage  tube 
being  inserted  for  the  escape  of  the  bile.  A 
few  days  after  the  operation,  the  jaundice  dis- 
appeared, showing  that  the  common  duct,  to 
a  certain  extent  at  all  events,  was  patent. 
Jaimdice,  however,  returned  after  a  time,  and 
in  a  more  aggravated  form.  Bile  continued  to 
flow  through  the  abdominal  wound  for  nearly 
three  months,  sometimes  very  little  and  some- 
I  limes  very  much,  the  fistula,   however,    never 


THE  CANADA  MEDICAL  RECORD. 


37 


permanently  closing  or  being  healecj.  Finally, 
the  woman  died  of  pneumonia,  which  was  very 
likely  the  result  of  her  condition.  The  opera- 
tion here  was  made  a  very  simple  one,  owing 
to  the  gall-bladder  being  so  large  and  easily 
handled. 

Dr.  Lafleur  wished  to  say  a  few  w^ords  with 
reference  to  the  innocuousness  of  bile  in  the 
peritoneal  cavity.  It  is  hard  to  say  when  the 
bile  is  septic  and  when  not.  In  regard  to  the 
first  case  mentioned  by  Dr.  Shepherd,  he 
thought  a  diagnosis  of  the  condition  could  be 
positively  made  from  the  physical  signs.  The 
character  of  the  tumor  was  clear,  because  the 
area  of  dullness  on  either  side  was  quite  con- 
tinuous with  the  liver  dullness,  an  absolutely 
flat  note  being  elicited  from  the  lower  border 
of  the  tumor  right  up  to  the  liver.  If  it  had 
been  renal,  as  Dr.  Shepherd  suggested,  there 
would  be  some  interspace  between  the  tumor 
and  the  liver  with  a  lighter  note.  Then  the 
feel  of  the  tumorwas  too  elastic  for  a  solid  growth. 

Dr.  Armstrong  said  that  Dr.  Roddick's  case 
recalled  to  his  mind  one  of  his  own  attended 
with  somewhat  similar  difficulties.  The  woman 
went  home  after  the  operation  with  the  bile 
-flowing  through  a  fistulous  opening  in  her 
abdomen.  After  an  absence  of  six  months  she 
returned  with  the  bile  still  flowing,  but  with 
her  stools  pretty  well  colored.  Dr.  Armstrong 
then  made  some  attempts  to  stop  the  escape 
of  the  bile  by  means  of  cotton  wool  plugs  and 
collodion.  A  second  effort  in  this  respect  was 
successful,  and  after  remaining  here  six  weeks 
without  any  sign  of  the  flow  breaking  out  again, 
she  went  home.  The  fistula  eventually  closed  up. 


ROUEN  MEDICAL  SOCIETY. 
Diphtheritic  Paralysis. — M.  Duboc  cal- 
led attention  to  the  frequency  of  paralysis  after 
diphtheria,  and  to  the  fact  that,  although  the 
light  forms  are  most  general  and  yield  to  purely 
hygienic  measures  or  tonic  treatment,  grave 
cases  yield  to  serious  complications,  and  some- 
times even  to  death,  by  extension  of  the  paraly- 
sis to  the  muscles  of  respiration  or  the  heart. 
He  reported  a  case  from  his  own  practice,  inter- 
esting from  the  gravity  of  the  affection  as  well  as 
its  quick  and  speedy  cure  by  electricity.  'I'he 
patient  was  a  married  woman  of  40  years,  of 
good  general  health,  who,  eight  years  previously 
had  suffered  from  a  tubercular  bronchitis,  and 
two  years  previously  from  angina  with  swelling 
of  the  glands  of  the  neck  which  was  cured  in 
about  fifteen  days.  She  contracted  diphtheritic 
angina  from  a  child  with  croup,  the  disease  being 
of  average  intensity.  On  the  twelfih  day  she  ex- 
perienced difficulty  in  swallowing  and  in  talking, 
speech  being  somewhat  nasal.  She  was  treated 
by  tonics,  and  as  the  condition  grew  worse  she 
consulted  M.  Duboc,  who  found  her,  three 
weeks  from  the  onset  of  the  disease,  very  much 
worn  out,  speech  nasal  and  incomprehensible 


and  very  fatiguing  to  the  ])atient,  who  found  it 
impossible  to  articulate.  The  vault  of  the  pal- 
ate was  lowered,  the  tonsils  touching  the  base 
of  the  tongue  and  entirely  disappearing.  The 
tongue  deviated  to  the  right,  showing  that  the 
paralysis  affected  the  left  side  more  than  the 
right.  The  roof  of  the  palate  remained  immo- 
bile in  attempts  at  singing,  speaking,  or  swal- 
lowing. It  was  insensible  to  touch,  and  titilla- 
tion  of  the  tonsil  produced  no  reflex.  The 
pharynx  was  not  sensitive,  and  its  functions 
were  impaired.  Deglutition  was  difficult  and 
almost  impossible,  soft  food  and  drinks  passing 
through  the  nasal  fosste,  causing  the  patient  to 
fear  suffocation  and  consequently  to  refuse  all 
nourishment.  The  tongue  itself  was  somewhat 
affected ;  the  respiratory  movements  were  20  per 
minute,  while  the  heart-beats  were  but  65  per 
minute.  M.  Duboc  placed  a  narrow  rheophore 
upon  the  vault  of  the  palate  and  a  wide  one 
upon  the  nape  of  the  neck,  using  an  induced 
current  of  feeble  intensity.  The  treatment  was 
continued  for  six  minutes,  the  electrode  being 
moved  about  on  the  affected  area,  and  from  the 
nape  of  the  neck  to  the  mastoid  apophysis. 
The  contractility  of  the  muscles  was  abolished, 
electric  sensibility  being  diminished  but  not 
absent,  as  the  patient  felt  the  opening  and  clos- 
ing of  the  current.  After  ten  sea/u'es  complete 
cure  resulted,  and  the  patient  could  speak  easily 
and  fluently. 

M,  Deshayes  had  treated  five  cases  of  diph- 
theritic paralysis  by  electricity  combined  with 
hydrotherapy,  all  recovering. 

Influenza  IN  Children. — M.  Bninon  called 
attention  to  the  large  number  of  children  who 
had  suffered  from  the  disease,  during  the  recent 
epidemic  at  Rouen,  from  Nov.  i,  1893,  to  Feb- 
ruary 15,  1894.  In  the  epdemic  of  1890  the 
society  had  observed  that  children  enjoyed 
almost  complete  immunity  from  the  disease. 
M.  Brunon  had  seen  twenty-five  cases  in  chil- 
dren in  his  practice,  these  belonging  to  thirteen 
families.  He  treated  sixty-nine  cases  of  in- 
fluenza in  adults  in  the  same  time,  the  propor- 
tion of  children  thus  being  large.  The  cases 
were  nearly  all  characterized  at  the  outse^  by 
vomiting,  and  loss  of  appetite,  while  the 
convalescence  was  long.  He  gave  in  such 
cases,  to  children  over  2  years  of  age,  from 
30  to  50 grammes  (i  to  i-'i  ounces)  of  raw 
meat  at  each  meal,  with  a  little  cognac, 
benzo-naphthol,  and  laxatives.  In  all  the  cases 
the  children  rapidly  lost  flesh,  and  he  found 
this  treatment  of  value  to  counteract  this.  The 
ra|)idity  of  diffusion  of  the  disease  in  a  family 
was  remarkable.  In  some  families  the  children 
were  the  first  to  be  affected,  the  adults  becom- 
ing ill  several  days  later. 

M.  Duboc  had  cured  several  cases  in  chil- 
dren by  cold  water  baths,  which  he  believed  to 
be  of  great  value  in  cases  com])licated  by  pul- 
monary ironbles.- (/uivt-rsa/  Alcdical  lournal. 


38 


THE   CANADA    MEDICAL   RECORD. 


gro^rcss    of    ^ciciuc. 


CANCER  A    LOCAL    DISEASE. 

The  evidence  for  this  doctrine  has  been 
strongly  presented  by  Dr.  Jennings,  in  liiswork 
on  "  Cancer  and  Its  Complications,"  the  second 
edition  of  which  has  been  recently  published  in 
London,  li  cancer  be  a  local  disease,  it  is  impera 
tive  that  not  only  those  tissues  which  are  seen  to 
be  subjecied  to  cancerous  infiltration,  but  some 
of  the  surrounding  tissues  and  the  neighboring 
lymphatic  glands  should  be  taken  away  by 
means  of  the  knife  at  as  early  a  date  as  possible. 
The  amount  of  personal  observation  given  in 
support  of  this  method  of  treatment  is  not  very 
great,  but  the  careful  analysis  of  the  work  and 
opinions  of  others,  and  the  comparison  of  the 
methods  of  termination  of  the  disease  under 
differer.t  methods  of  treatment  amply  warrant 
Dr.  Jennings  in  drawing  very  wide  and  general 
conclusions. — Bn'f.  MciL  Jour. 


NEW    OBSERVATIONS 
RHCEA. 


IN    GONOR- 


At  the  recent  meeting  of  the  German  Derma 
tological  Association,  considerable  time  was  de' 
voted  to  the  discussion  of  the  etiology  of  gonor- 
rhcea,  and  among  the  interesting  points  brought 
out,  an  observation  by  Wertheim  is  deserving  of 
especial  attention.  This  careful  investigator 
has  found  that  gonococci  obtained  from  the  se- 
cretions of  chronic  gonorrhoea  can  be  cultivated 
so  as  to  acquire  a  high  degree  of  virulence,  and 
wlien  inoculated  in  the  urethra  of  the  patient 
from  whom  they  were  derived  will  give  rise  to 
an  intense  gonorrhoeal  inflammation.  It  has 
been  quite  frequently  observed  that  patients 
suffering  from  latent  gonorrhoea  at  the  time  of 
marriage  have  infected  their  wives,  and  at  a 
later  period  acquired  from  them  in  return  an 
acute  urethral  inflammation.  Wertheim's  ex- 
periments are,  therefore,  of  importance  in  afford- 
ing a  rational  and  scieniific  explanation  of  this 
clinical  observation. — Inter.  Jour,  of  Surgery. 

ANESTHESIA 

Geheimrath  Gurli  read  the  yearly  report 
of  the  collective  inquiry  into  the  statistics  of 
narcotization.  The  report  embraces  51,846 
narcoses  of  the  year  1893,  of  which  32,723 
were  produced  by  c.loroform.  11,617  by  ether, 
3896  by  chloroform  and  ether,  750  by  chloro- 
form, ether  and  alcohol  (Billroth's  mixture), 
and  2769  by  ethyl  bromide.  A  number  of 
laughing-gas  narcotizations  are  added.  These 
51,846  surgical  narcoses  count  20  deaths,  and 
of  these,  again,  i  7  are  after  chloroform,  'llius, 
the  average  proportion  was  i  death  10  2587 
narcoses  and  1  death    to    1924  chloroform  nar- 


coses. In  the  four  years  during  which  the  tn- 
quiry  has  been  carried  on,  only  i  death  after 
ether  has  been  noleJ,  and,  accordingly,  the  use 
of  ether  has  increased  from  6200  cases  in  1892 
to  11,600  in  1893.  The  chloroform-ether  mix- 
ture was  used  1200  times  in  1892  and  3800 
times  in  1893.  Pictet's  chloroform  (purified 
by  exposure  to  extremely  low  temi)erature) 
was  used  3182  times,  as  against  708  in  1892. 
In  spite,  however,  of  this  and  other  purified 
chloroforms  at  present  in  use,  death  during 
chloroform  narcosis  has  not  proved  prevent- 
able, and  the  general  opinion  now  is  that  't  is 
not  caused  by  the  chemical  impurities  contain- 
ed in  ordinary  chloroform. — British  Medical 
Jourfia/,  Mays,   '894. 

GROWING  PAINS. 

In  a  very  instructive  article,  Dr.  P.  B.  Bennie 
{Archie es  0/ Pediatrics,  lsia.y,  1894)  states  that 
this  malady  with  its  concomitant  growing  fever, 
like  its  congener,  disorders  of  dentition  vanish- 
ing from  the  realm  of  pathology  through  that  of 
fancy,  is  fast  sinking  into  oblivion  in  the  medical 
literature  of  the  past.  As  a  separate  morbid 
entity  it  exists  now  principally  as  an  article  of 
faith.  The  cases  diagnosed  as  growing  pains 
have,  in  his  experience,  usually  proved  to 
belong  to  one  of  the  following  condi lions  : 
myalgia  from  the  fatigue  of  ,  over-exertion, 
rheumatism,  diseases  of  the  joints  and  bones^ 
fevers,    and  adenitis. 

TREATMENT  OF  HYDROCELE. 

Dr.  Garvin  {Boston  Med.  cl  Surt;.  Jour.)  has 
emi)loyed,  during  tiie  past  six  years,  injection 
of  half  an  ounce  of  a  solution  composed  of 
equal  parts  of  carbolic  acid,  alcohol  and  glyce- 
rine ;a  small  bulb  syringe  answers  well.  The 
fluid  is  allowed  to  remain.  The  skin  surround- 
i  g  the  canula  should  be  protected  from  irri- 
tation with  a  little  gauze  or  absorbent  cotton. 
The  injection  is  practically  painless,  patients 
are  able  to  attend  to  their  business,  and  a  cure 
is  effected  in  from  two  to  four  weeks. 

ACCENTUATION  OF   THE  PULMO- 
NARY SOUND  IN  PERITYPHLITIS. 

Dr.  Julius  Mannaberg.  of  Vienna,  states 
that,  of  88  cases  of  perityphlitis  observed  from 
1S82  to  1892  in  the  wards  of  Professor  Noth- 
nagel,  he  was  struck  by  the  fact  that  the  pulmo- 
nary second  sound  was  accentuated,  though 
no  explanation  of  the  symptom  was  given. 
Since  then  13  cases  have  come  under  observa- 
tion in  the  same  wards,  and  in  4  of  these  the 
sound  was  markedly  accentu.ned  ;  in  7  it  was 
distinctly  louder  than  the  aortic  sound  ;  in  the 
2  remaining  cases  both  second  sounds  were 
loud,  and  in  i  of  these    the   pulmonary    sound 


THE   CANADA    MEDICAL    RECORD. 


39 


was  reduplicated.  From  careful  observation 
lie  is  convinced  that  in  cases  of  perityphlitis 
accentuation  of  the  pulmonary  second  sound 
is  a  very  frequent  symptom,  though  he  is  unable 
to  account  for  it.  It  is  well  known  that  Skoda 
first  recognized  pulmonary  accentuation  in 
mitral  disease,  and  that  it  is  an  indication  of 
high  pressure  in  those  affections  in  which  there 
is  increased  resistance  to  the  work  of  the  right 
ventricle.  Interference  with  the  pulmonary 
circulation,  due  to  elevation  of  the  diaphragm 
through  increased  volume  of  the  abdominal 
contents,  as  in  meteorism,  ascites,  and  the  like, 
is  also  a  matter  of  common  experience  ;  and 
in  this  way  also  pulmonary  accentuation  may 
be  produced.  Dr.  Mannaberg  believes  that  the 
rise  of  blood-pressure  after  a  meal  is  at  least  in 
part  due  to  the  same  cause,  and  not,  as  Potain 
maintains  {De  la  dilatation  du  cceur  ;  la 
Medccine  Moder/ie,  November  26,  1892),  to  a 
reflex  contraction  of  the  lung-capillaries,  result- 
ing from  digestion.  In  the  10  positive  cases 
recently  observed  by  the  author,  there  was  no 
distension  of  the  abdomen,  and  consequently 
no  undue  pressure  on  the  diaphragm  ;  indeed, 
marked  meteorism  is  rare  in  uncomplicated 
cases  of  perityphlitis.  There  was  no  dyspnoea, 
and  the  other  symptoms,  such  as  pain  and 
pyrexia,  would  not  account  for  the  accen- 
tuation, which  lasted  after  the  acute  stage,  and 
was  present  even  when  the  patient  was 
recovering.  Further  observation  is  necessary 
to  determine  whether  the  symptom  is  generally 
present  in  perityphlitis  and  other  abdominal 
affections,  and  whether  it  is  of  any  special 
value  in  diagnosis. —  Practitioner,  April,    1894. 

RARE  CASE  OF  TRAUMATIC  CYST 
OF  THE  STOMACH. 

Dr.  Ziegler  describes  a  very  interesting  case 
of  a  man,  aged  24  years,  who  was  crushed  bet- 
ween two  cars  on  the  railroad,  and  injured  in 
the  abdomen.  He  became  unconscious,  and 
was  taken  home,  where  he  complained  of_ 
severe  abdominal  pain,  and  suffered  for  twelve 
hours  from  haemoptysis.  The  abdonen  was 
sensitive,  but  there  was  no  swelling.  Micturition 
was  painful  and  the  urine  bloody.  The  temper- 
ature was  normal.  Under  the  influence 
of  local  refrigeration  and  opium  in  Targe 
doses,  the  haematuria  and  haemoptysis  disap- 
peared, the  appetite  returned,  and  the  patient 
left  his  bed.  At  the  end  of  three  weeks  the 
abdomen  again  became  painful  in  the  left  upper 
portion,  and  a  tumor  the  size  of  an  apple, 
elastic  and  pulsatile,  was  felt  beneath  the  false 
ribs.  It  increased  in  size  until  it  reached  the 
median  line;  vomiting,  meteorism,  consti- 
pation and  collapse  caused  the  case  to  appear 
like  one  of  intestinal  occlusion.  Puncture 
gave  exit  to  three-fourth.5   of  a    litre  (quart)  of 


pus,  and  caused  the  disappearance  of  the  pain. 
The  tumor  re-appeared,  without  fever,  but  the 
patient  felt  a  sense  of  pressure  which  pre- 
vented him  from  eating,  and  caused  vomiting, 
although  his  appetite  was  good.  He  then  en- 
tered hospital,  and,  as  it  was  impossible  to 
mike  an  exact  diagnosis,  an  exploratory  laparo- 
tomy was  performed,  when  a  tumor  was  found, 
occupying  the  entire  anterior  wall  of  the  sto- 
mach, extending  to  the  pylorus  ;  its  upper 
portion  was  hidden  under  the  diaphragm,  and 
its  limits  could  not  be  perceived.  The  epiploon 
and  posterior  wall  of  the  stomach  were  normal. 
Pimcture  gave  exit  to  3  Hires  (quarts)  of  bloody 
fluid,  and  the  sac  was  seen  10  be  situated  in 
the  iliink  portion  of  the  anterior  wall  of  the  stom- 
ach. The  patient  recovered  without  accident, 
and  seven  months  later  was  well,  through  he  still 
felt  some  abdominal  pain  on  being  chilled, 
and  was  obliged  to  eat  wiih  moderation. 
Ziegler  attributes  the  formation  of  the  cyst  to 
detachment  of  the  wall  of  the  stomach  by  the 
injury. —  Milne  hener  medicinische  Woe  hens- 
chrift,  No.  6,  1894. 

HOMES  FOR  CONSUMPTIVES. 


The  other  practical  line  of  action  is  the  esta- 
blishment of  homes  for  consumptives.  This  is 
truly  a  field  with  the  widest  scope  of  action  for 
the  lover  of  his  kind.  Surely  we  shall  soon  sje 
some  large-hearted  and  open-handed  son  of 
Ontario,  whom  fortune  has  been  kind  to,  setting 
apart  some  hundreds  of  acres  of  the  thousands 
of  square  miles  which  can  yet  be  had  almost 
for  the  asking,  for  a  real  "  Home  for  Consump- 
tives." Such,  exists  m  the  New  York  Adiron- 
d  icks  solely  as  the  r^^alized  dream  ofphilanthrop- 
isis  ;  such,  too,  are  found  in  the  Grindenwald 
and  in  the  forests  of  Brittany.  My  dream  is 
to  see  in  some  Canadian  forest  a  microcosm. 
We  hxve  in  the  province  some  six  colonies, 
hundreds  of  acres  in  extent,  set  apart  for  the 
4,000  mental  unfortunates  ;  but  which,  instead 
of  madhouses,  are  becoming  for  them  "  abodes 
of  paradise."  How  much  easier,  how  much 
more  successful,  with  a  class  of  sufferers  with 
fliculties  intact,  with,  in  many  cases,  the  fairest 
forms  and  most  splendid  intellects,  to  establish 
a  village  where  agriculture  and  iiorticulture, 
where  tree  planting  and  apiaries,  with  other  oc- 
cupations, might  all  be  carried  on  in  the  out- 
door air;  while  a  dozen  useful  occupations  might 
be  found  for  indoor  employment.  To  me  the 
hospital  idea  by  itself  for  consumption  is  just 
as  repellant  as  the  mad-house  idea  of  former 
limes  for  the  mentally  deranged.  What  more 
depressing  than  sending  a  consumptive  girl  to 
a  hospital  to  die?  What  more  beautiful  or 
health-giving  than  sending  this  bud  of  woman- 
hood to  live  amidst  a  garden  offlowers? — Ex, 


40 


THE   CANADA   MEDICAL   RECORD. 


NEW  METHOD  OE  EXAMINING  FOR 
RENALCALCULUS. 

Dr.  Charles  P.  Noble,  of  Philadelphia, 
describes  a  case  in  whicii  he  performed  an 
operation  enabling  him  to  examine  ihe  kidney,  j 
the  pelvis  of  the  kidney,  and  about  one  inch  of 
the  ureter.  He  made  the  usual  incision  in  the 
loin  down  to  and  through  the  peri-renal  fat, 
exposing  the  lower  end  of  the  kiduey.  Willi 
the  index  finger  the  kidney  was  then  separated 
from  its  connective-tissue  attachments  and 
gradually  drawn  down  into  and  out  through 
the  wound,  so  that  it  was  entirely  outside. 
It  was  now  a  very  simple  matter  to  explore 
the  kidney  by  thumb-and-finger  pressiire,  and 
to  make  certain  that  it  was  in  a  normal  con- 
dition. It  was  equally  easy  to  examine  the 
pelvis  of  the  kidney  and  to  determine  that  this 
contained  no  stone.  Perhaps  one  inch  of  the 
ureter  also  was  within  reach.  As  nothing 
abnormal  could  be  felt,  the  kidney  was  replaced 
within  the  abdomen  and  the  incision  sutured 
in  the  usual  way — buried  silkworm-gut  sutures 
being  placed  in  the  muscular  layers,  and  super- 
ficial silkworm-gut  sutures  in  -the  skin.  Dr. 
Noble  recommends  the  adoj^tion  of  this  method 
whenever  the  symptoms  point  to  the  i)resence 
of  stone,  and  are  sufficiently  serious  to  cause 
the  patient  to  become  an  invalid.  Upon  theo- 
retical grounds  the  procedure  would  not  be 
applicable  in  cases  of  abscess  of  the  kidney, 
as  the  latter  would  be  fixed  and  not  easily 
separated  from  its  connective-tissue  bed. 
Moreover,  it  would  be  enlarged, and  there  would 
be  the  risk  of  rupturing  the  pus-sac,  perhaps 
into  the  peritoneal  cavity. — American  Ther- 
apist. March,  1894. 

PRIMARY  CANCER  OF  THE  GALL- 
BLADDER. 

J.  Dallemagne  has  had  occasion  to  make  an 
autopsy  in  four  cases  of  this  rare  disease,  and 
histological  examination  leads  him  to 
believe  that  it  generally  takes  its  origin  in  the 
epithelium  of  the  gall-bladder,  that  it  is  usually 
of  the  scirrhous  type,  and  that  its  evolution 
seems  in  no  way  to  affect  the  parenchyma 
of  the  liver,  which  seems  to  oppose  a  special 
resistince  against  the  invasion  of  the  neo- 
plasm. It  was  but  rarely  that  he  encountered 
small  metastatic  nuclei  or  infectious  nodules  in 
the  liver.  The  clinical  diagnosis  is  difficult, 
as  the  tumor  progresses  wiihout  causing  any 
cachexia,  icterus,  or  other  symptom  which 
would  call  attention  to  the  gall-bkiddcr.  It  is 
l^articulaily  a  disease  of  the  feminine  sex,  and 
is  fieciucnily  accompanied  by  calculi,  though 
he  believes,  with  Stiller,  Coinil  and  Ranvier, 
that  the  appearance  of  the  latter  is  consecutive 
to  the  carcinomatous  affection. — Ln  Cliniquc, 
March  15, 1894. 


THE  URINE  I\  EN  I  ERIC  FEVER. 

In  a  lengthy  study  of  tiie  urine  in  enteiic 
fever,  Oriou  states  :  i.  The  more  elevated 
the  temperature,  the  more  active  the  oxidation, 
the  fever  masking  a  serious  condition,  or  com- 
plicated by  the  so-called  typhoid  condition.  2. 
In  the  three  clinical  forms,  benign,  clinical 
and  grave,  whether  fatal  or  not,  as  well  as  in 
complications  of  the  ty))hoid  state,  any  increase 
of  fever  is  followed  by  an  increase — if  not 
proportional,  at  least    parallel — of  oxidation. 

3.  Any  deviation  from  this  principle  is  readily 
explained  by  one  of  the  numerous  causes  cap- 
able of  modifying  the  laws  of  organic  exchange. 

4.  The  typhoid  state,  far  from  owing  its 
origin  in  every  instance  to  retention  in  the 
organism  of  the  products  of  combustion,  often 
coincides  with  an  abundant  elimination  of 
these  \)XO^\.\z\'?,.-- Revue  de  Mcdccine,  January, 
1894. 

AN    EXTREME    CASE  OF  ASCITES. 

C.  C.  Cotton,  of  Point  Isabel,  Ind.,  relates 
the  case  of  a  patient  who  died  recently,  a  man 
of  51  years,  who  had  suffered  from  ascites  for 
three  and  one-half  years.  The  following  table 
will  show  the  progress  of  the  disease,  and  the 
increase  from  year  to  year  in  the  frequency  of 
tappings  : — 

Time.     Xiuiiber  Times    Average  <,)uaiititv    Total  Quantity 
Tappo.l.  of  Fluid.  of  Fluid.  " 


6  months. 
I   year. 
I  year. 
I    year. 


7 
34 
55 
71 


30  pounds. 
27  pounds. 
21  pounds. 
iS  pounds. 


32  yea'S-  '57 


210 

91S 

1155 
1278 

3561 


111  addition  to  the  extraordinary  severity 
and  duration  of  this  case,  what  is  possibly 
more  remarkable  is  that  the  patient  soon 
became  familiar  with  the  operation,  and  could 
perform  it  himself,  which  he  did  with  his  own 
hands  more  than  one  hundred  times. — Medical 
World.,  March,   1S94. 

RENAL  HAEMORRHAGE  FROM  AN 
UNUSUAL  SOURCE. 

Dr.  Collier  reports  the  following  case  :  A 
laborer,  aged  36,  shortly  alter  lifting  a  heavy 
weight,  was  seized  with  pain  in  the  right  lumbar 
region,  and  began  to  pass  water  of  a  dark-porter 
color.  On  exumiuaiion  there  was  very  decided 
fullness  and  marked  tenderness  over  the  region 
of  the  right  kidney.  The  urine  contained  a 
large  amount  of  blood,  vaiying  considerably 
from  time  to  time  ;  under  the  microscope  could 
be  seen  blood-corpuscles,  large  round  and 
tailed  cells,  and  squamous  ci)ithelium  in  great 
abundance.     A  fortnight  from    the  onset  there 


THE  CANADA  MEDICAL  RECORD. 


41 


supervened  total  suppression  of  urine,  vomiting, 
muscular  twitching,  and  great  drowsin.'ss  ; 
and  forty-eight  hours  later  ihe  man  died.  It 
was  ascertained  that  he  had  been  under 
treatment  four  months  jn-eviously  for  chronic 
rheumatism  ;  no  disease  of  the  kitlneys  was 
tlien  suspected.  O  1  post  niniicm  t  xannn  ilioii 
both  kidneys  were  found  much  enlarged,  an.d 
their  substance  was  almost  entirely  converted 
into  closely-aggregated  cysts.  The  light 
kidney  was  about  the  si'/e  i^f  a  cocoa  nut.  A 
large  haemorrhage  had  taken  place  between 
the  capsule  and  the  kidney,  dissecting  off  the 
capsule  ;  and  had  burst  into  one  of  the  cysts, 
which  in  turn  had  ruptured  into  the  pelvis. 
The  ureters  and  bladder  were  perfectly  healtiiy. 
— Binniiighaiti  Medical  Review,  March,  189^. 

WATER    IN  TYPHOID    lEVEP,. 

Urge  your  p.itients  to  drink  a  great  deal  of 
cold  water.  The  more  I  practice  this  plan, 
the  more  I  am  conviiiced  of  its  beneficial 
effects.  In  many  cases  I  have  learned  my 
patients  to  drink  five  quarts  of  cold  water  in 
twenty-four  hours,  and  I  think,  to  realize  the 
full  benefits  of  this  plan,  it  should  be  carried  to 
this  extent.  Tliere  are  no  contra-indications  to 
this  treatment.  Many  observers  believe  that 
its  beneficial  effects  on  a  feeble  heart  are  well 
marked.  In  this  condition  it  certainly  cannot  be 
contra-indicated.  In  the  lowering  of  the  fever, 
disappearance  of  the  dr)  ness  of  the  tongue 
and  mouthj  sedative  effects  on  the  nervous 
system,  and  the  eliminative  fanciions  of  the 
kidneys  are  easily  observed. 

This  plan  facilitates  the  oxidation  of  toxines, 
and  aids  nature  in  removing  or  eliminating 
the  refuse  material  which  always  accumulates 
in  the  system  in  continued  fevers, — a  natural 
result  to  an  impaired  organic  function .  You 
can  observe,  as  evidence  of  the  increased 
activity  of  the  kidneys  and  skin,  the  great 
qua'itities  of  urea  that  is  eliminated  by  the 
kidneys,  its  quantity  fluctuates  with  the  amount 
of  water  taken  into  the  system.  This  mctiiod 
is  very  pleasant  and  acceptable  to  the  patient. 
Of  course  it  does  not  influence  the  course  or 
direction  of  the  disease. —  Charlotte  Med.Jow- 

TREATMENT  OF  RED  NOSE. 

Helbing  yTlierap.  Ilfoiiatshe/te,  January, 
1894)  calls  attention  to  the  treatment  ol  red 
nose — a  condition  of  little  importance,  it  is  true, 
but  decid.'dly  anioying  to  the  possessor.  The 
condition  he  refers  to  is  the  bluish-red  color  of 
some  noses  upon  remaining  for  some  ti  ne  in  a 
warm  room,  coming  in  from  the  cold  air,  eic. 
The  treatment  he  advises  is  the  systematic 
application  of  the  galvanic  current.  Both  poles 
are  applied  to  the  nose,  and  are  continually 
moved  about.  The  strength  of  the  current  he 
has  regulated  by  the  amount  of  burning  com 


plained  of  by  the  patient.  Five  to  eight  elements 
of  .m  oidinary  battery  s'lftice.  J  the  i)atieni 
is  very  sensitive,  the  anode  may  be  applied  to 
the  zygoma  and  the  nose  gently  stroked  with  the 
cathode.  Tliis  application  is  followed  by  an 
intense  reilness  of  the  skin,  which  lasts  for  an 
interval  of  two  to  forty  eight  hoins.  Too  strong 
currents  must  be  avoided  on  account  of  the 
excessive  irrilalion  they  produce.  The  appli- 
cati'tns  are  repeated  at  intervals  of  two  or  three 
d.iys.  The  method  requires  patience  and  a 
considerable  number  of  applications  (at  least 
ten  to  fifteen),  and  the  author  has  had  to  hold  as 
many  as  thirty  sittings.  The  author  has  used 
the  method  in  thirty-one  cases,  and  always 
with  success,  and  gives  reports  of  two  of  the 
more  obstinate  cases.  —  Ciiicui.  Lancet-Clinic. 

SECOND  HAND  SYRINGES. 

It  is  a  German  practice  of  mediaeval  origin 
attended  with  decided  danger  of  luetic  infec- 
tion to  borrow  syringes  from  drug  stores. 
This  practice,  which  conies  down  from  the 
time  when  the  apothecary  was  expected  to 
administer  the  clysters  presciibed  by  the  physi- 
cian, apj^ears  occasionally  in  the  United  Slates. 
A  recently  imported  German  fraulein  lately 
abashed  a  modest  Chicago   pharmacist  by  the 

following  request  :  '  Dear  Mr. ,  lend  me 

your  injection.      I  will  return  it  in  a  couple  of 
hours.'  " 

The  above  extract  from  the  Aicdical 
Standard  hnngs  to  mind  an  occurrence  of '61, 
when  Tennessee  was  organizing  her  troops  to 
join  the  other  Southern  Stales  in  their  little  four 
years'  tournament  that  is  now  happily  a  matter 
of  the  past. 

The  medical  purveyor  at  Nashville  was  a 
canny  Scot,  and  knowing  that  glass  manufac- 
tories did  not  exist  in  the  South,  in  addition  to 
all  the  glass  syringes  that  he  could  procure 
from  the  drug  stores,  lent  out  circulars  to 
many  physicians  for  the  purpose  of  purchasing 
syringes,  ev.n  those  that  had  seen  service — 
these  he  had  thoroughly  cleansed  and  prepared 
for  use,  and  issued  them  proportionately  on 
the  requisitions  made  on  him. 

One  regimental  surgeon,  recognizing  in  those 
supplied  to  him  some  that  had  previously  been 
used,  became  somewhat  incensed,  and  wrote  a 
very  tart  communication  to  Surgeon-General 
Newnan,  stating  that  "  the  members  of  his 
commaid  were  first  class  gentlemen,  and 
would  not  submit  to  the  indignity  of  using 
second-hand  syringes." 

I  he  surgeon  general  tbrwarded  the  com  nu- 
nication  to  the  medical  purveyor,  which  was 
respectfully  returned  by  the  genial  and  witty 
son  of  "  Auld  Reekie  "  with  the  endorsement  : 
"  If  the  within  mentioned  first-class  gentlemen 
would  refrain  from  the  use  of  other  second- 
hand articles  needless  to  mention,  they  would 
not  need  syringes  of  any  kind." 


42 


THE  CANADA  MEDICAL  RECORD. 


KENTUCKY  SCHOOL    OF    MEDICINE. 

"  At  the  meeting  of  the  Association  o\ 
American  Medical  Colleges,  held  in  San  Fran- 
cisco, on  June  7,  1894.  the  Kentucky  Sch.jol  of 
Medicine,  of  Louisville,  Ky.,  was  dropped  from 
membership  in    the  Association," — Exchange. 

The  Kentucky  School  of  Medicine  was  never 
a  member  of  the  American  Medical  ("oUege 
Association,  but  the  requirements  in  the  cata- 
logue recently  issued  are  higher  than  are  the 
requirements  of  the  Association.  The  school 
has  been  conducted  in  strict  accordance  with 
the  requirements  observed  by  the  most  success- 
ful and  reputable  colleges,  and  no  school  has 
been  more  respected  by  the  honorable  members 
of  the  medical  profession.  \\\  laboratory,  didac- 
tic and  clinical  work  the  school  has  adopted  the 
most  approved  methods,  and  now  that  tlie 
Faculty  have  completed  a  large  hospital,  adjoin- 
ing the  College,  no  school  in  the  country  can 
offer  better  practical  and  clinical  advantages. — 
Matthews   Med-  Quarterly. 

DANGERS  OF  THE  LONG  RECTAL 
TUBE. 

Harrison  Cripps  (^British  Medical  J<nirnal., 
No.  1723).  Traditions  die  hard,  and  notwith- 
standing the  condemnation  of  the  long  rectal 
tube  by  Brodie,  Treves,  and  many  other  emi- 
nent authorities,  I  still  find  that  in  most  cases 
of  obstruction  or  supposed  obstruction  the  tube 
has  been  introduced.  Fortunately  these  tubes 
are  fairly  soft,  so  that  in  a  capacious  rectum, 
when  ihey  impinge  and  are  arrested  about  op- 
posite the  promontory  of  the  sacrum,  they  sim- 
ply coil  up  and  do  no  harm.  If  stiffer  ones  are 
used,  the  patient's  life  is  placed  in  imminent 
risk.  A  patient  at  St.  Bartholomew's  Hospital 
was  to  be  operated  on  for  ruptured  perineum. 
In  order  to  increase  the  supposed  efRcucy  of  the 
injeciion,  a  quart  of  soap  and  water,  with  some 
ounces  of  oil,  w^erc  injected  by  means  of  a  long 
tube.  The  injection  never  returned.  A  few 
hours  afterward,  owing  to  the  acute  symptoms 
of  the  patient,  1  assisted  one  of  my  colleagues 
in  opening  the  abdomen.  The  soap  and  water 
and  oil  we  found  in  the  abdominal  cavity,  and 
a  hole  below  a  redujjlicated  fold  in  the  upper 
jjart  of  the  rectum.  The  patient  died.  The  idea 
that  these  tubes  can  be  generally  ])assed  into 
and  beyond  the  sigmoid  fie.xure  is  a  pure  delu- 
sion, save  in  the  rarest  circumstances.  As  a 
means  of  diagnosis,  or  of  treating  strictures 
beyond  the  reach  of  the  finger,  tubes  of  any  kind 
are  absolutely  useless,  li  a  stricture  is  actually 
present,  it  would  be  100  to  i  against  the  long 
tube  or  bougie  entering  it,  for  it  would  almost 
certainly  catch  in  the  (■«/-^<'-.v<?r  generally  cfiused 
by  the  invagination  of  the  stricture.  If  a  stric- 
ture be  not  present,  the  arrest  of  the  bougie  by 


the  sacral  promontory  leads  to  delusive  diag- 
nosis.. Brodie,  in  his  lectures,  alludes  to  a  case 
in  which  a  worthy  practitioner  had  spent  over 
one  hundred  and  fifty  hours  in  dilating  a  sup- 
posed stricture  situated  high  up.  The  treatment 
had  extended  over  a'period  of  a  year.  Brodie 
who  was  present  at  the  post-viortem  examination, 
found  theri  was  no  sign  of  a  stricture,  the  bougie 
becoming  arrestied  by  the  curve  of  the  sacrum. 

THE  BEST  TREATMENT  OF  HEMORR- 
HOIDS. 

Edw.  S.  Stevens  (^Cincinnati  Lancet  Clinic). 
If  the  cases  seen  by  the  practitioner  are  suffi- 
ciently numerous  to  justify  him  in  providing 
himself  with  the  necessary  instruments,  he  will 
find  the  clamj)  and  cautery  method  of  treatment 
an  ideal  one,  and  it  has  not  been  intended  to 
jacfer  the  ligature  to  it  without  some  qualifi- 
cation of  the  statement  of  preference.  While 
not  50  simple  of  performance,  it  is  followed  by 
less  distress,  and  recovery  is  usually  moie 
speedy  after  it  than  the  ligature.  The  surgeon 
who  permits  his  patients  to  walk  out  on  the 
fourth  day,  however,  as  has  b  en  reported,  does 
not  decide  for  their  best  interest.  A  week  or 
ten  days  should  elapse,  unless  an  examination 
shows  the  wounds  healed.  If  resorted  to,  two 
or  three  precautions  are  best  heeded.  Do  not 
use  it  on  tumors  high  up  in  the  rectum.  Open 
the  clamp  slowly,  and  if  there  is  any  tendency 
to  bleed,  screw  up  the  clamp  and  again  apply  the 
cautery.  The  cautery  is  sufficiently  hot  when 
dull  red,  and  the  part  of  the  stump  to  which 
attention  should  be  paid  in  applying  the  cautery 
is  that  farthest  from  the  operator, — that  is, 
where  the  vessels  enter. 

Before  either  operation  see  that  the  bowels 
are  thoroughly  emptied,  and  after  it  introduce 
an  opium  suppository. 

There  are  one  or  two  other  methods  advised, 
but  they  are  not  all  that  could  be  desired.  One 
of  them,  called  after  the  name  of  an  eminent 
English  surgeon,  consisting  in  excision  of  the 
"  whole  of  the  pile-producing  area,"  deserves 
to  be  forgotten,  not  because  it  is  not  simple,  but 
because  it  is  not  safe. 

A  form  of  hemorrhoidal  disease  characterized 
by  sessile  granulations  which  bleed  easily  is 
l)est  treated  by  the  very  old  method  of  apply- 
ing nitric  acid.  Introduce  a  speculum,  dry  tlie 
parts  .villi  gauze,  and  touch  the  whole  granular 
surface  again  and  again  with  a  bit  of  cotton 
moistened  with  the  acid,  but  containing  so  little 
that  it  will  not  run  over  the  parts  not  diseased. 

Lastly,  before  beginning  any  treatment,  look 
out  for  complications.  Especially  in  women 
should  the  i)elvic  organs  other  than  the  rectum 
be  examined.  In  children,  examine  the  urinary 
organs. 


THE   CANADA   MEDICAL    RECORD. 


43 


THE  CANADA  MEDICAL  RECORD 

Published  Montiii.y. 


Sn'iS-riplio/i  /'rice,  $\.00  per  a}uium  in  adrance.     Sin^/'e 
Cojiies,  10  citf. 

EDITORS : 

A.  LAPTHOJRNSMirH,  B.A„M.D.,  M.R.C.S.,  Eng.,  F.O-S. 

London. 
F.  WAYLAND  CAMPBELL,  M.A.,  M.D.,  L.R.CP..  London 

ASSISTANT  EDITOR 
EOLLO  CAMPBELL,  CM-,   M-D- 

!N[;ike  all  Cheques  or  P.O.  Mouey  Orders  for  subscription  or 
advertising  payable  to  JOHN  LOVELL  &  SON,  23  St.  Nicho- 
las Street,  Montreal,  to  whom  all  business  communications 
ghould  be  addressed. 

All  letters  on  professional  subjects,  books  for  review  and 
exchanges  should  be  addressed  to  the  Editor,  I)r,  Lapthoru 
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Writers  of  original  communications  desiring  reprints  can 
have  them  at  a  trifling  cost,  by  notifying  JOHN  LOVELL  & 
SON,  immediately  on  the  acceptance  of  their  article  by  the 
Editor. 


MONTREAL,  NOVEMBEE,  1894. 


COUNTY  SOCIETIES. 

More  than    ever   are    we   convinced  of   the 
need  of  belter  organzation  of  the    medical  pro- 
fession in  the  Province    of  Quebec.     Cases   of 
the  greatest  interest   are    occurring    every  day, 
througliout    the  country,     the    experience    of 
which  is  lost  to  science  because  they  are  never 
recorded.     If  they  were  reported,  whether  the 
result  was  successful  or  otherwise,    the  lesson 
which    they    could    teach    might    and   almost 
surely  would  be    the    means   of  saving   many 
other  lives.     So  that    each  one  has    to   go  on 
sacrificing  human  lives  until  he  has  gained  an 
experience  for   himself,  and  then  when  he    has 
learned  how  to  save  many    cases  which  in  his 
earlier  years  he  used  to  lose,  he  dies,  and   also 
his  knowledge    dies  with  him.     If  there    had 
been   a   medical    society  in  his  town,  he  might 
before  his  death    have  imparte  i    much    of  the 
knowledge  which  he    had  acquired   during  his 
lifetime  of  sad    experiences    to   the  men   who 
were  to-succeed  him,    and    thus   the   younger 
men  might  begin  where  the  older  men  left   off. 
It  is  almost  incredible  that  there  is  no  Province 
of  Quebec   Medical  Assocation  ;    that  there  is 
no  City  of  Quebec  Medical   Society;    no   City 
of  Sherbrooke  Medical  Society  ;no  Lennoxville 
Medical      Society  ;      no     Richmond     Medical 
Society,  and  so  on,  throughout  the  whole  list  of 
towns  in  this  Province,  for  apart  from  the  three 
English  and  two  French   Medical  Societies   in 
Montreal  and  two   county  Societies  which  meet 


only  twice  a  year  in  the  Eastern  Townships, 
there  are  no  Medical  Societies  in  the  Province 
of  Quebec,  and  the  good  work  being  done 
throughout  the  province  is  lost  to  the  profession 
and  the  world.  We  consider  this  state  of  affairs 
a  great  misfortune.  To  give  one  instance  as 
regards  the  City  of  Quebec,  we  recently  received 
a  visit  from  one  of  the  great  surgeons 
of  the  world,  who  mentioned  that  during 
a  visit  to  Q'lebec  this  summer  he  thought 
he  would  look  up  some  of  the  surgeons 
of  that  city.  He  had  never  seen  the  name 
of  a  Quebec  surgeon  in  any  of  the  medi- 
cal journals,  of  which  he  is  a  keen  reader, 
and  it  was  only  with  difficulty  that  he  at  last 
succeeded  in  obtaining  the  name  and  address 
of  one,  Dr.  Ahcarn,  upon  whom  he  straightway 
called.  The  surgeon  was  just  going  to  an  opera- 
tion, to  which  the  great  man  was  inviceJ,  and,  to 
his  astonishment,  as  he  informed  us,  to  witness 
one  of  the  most  difficult  as  well  as  the  most  skill- 
ful pieces  of  abdominal  surgery  he  had  ever  seen. 
And  yet  Quebec  is  looked  down  upon  by  the 
medical  and  surgical  world  as  a  city  of  the  dead, 
simply  because  there  is  no  Medical  Society  at 
which  such  cases  as  the  above  might  be  report- 
ed and  given  to  the  world.  At  the  Marine 
Hospital  in  Quebec,  more  than  twenty  years 
ago,  a  man  was  brought  in  one  night  with  his 
abdomen  ripped  open  by  a  dagger,  the  bowels 
cut  across  several  places,  and  faeces  escaping 
from  them.  The  Superintendent,  Dr.  Catellier, 
washed  them  thoroughly,  sewed  the  ends  to- 
gether with  a  double  row  of  sutures,  and  closed 
the  abdomen,  and  the  man  recovered.  This  case 
lies  buried  in  the  records  of  the  Hospital,  in- 
stead of  being  reported  to  a  Medical  Society  and 
recorded  in  the  Medical  journal ;  and  we  know 
of  many  similar  instances.  The  forming  of  a 
Medical  Society  is  not  such  a  tremendous  under- 
taking. One  of  the  young  men  of  the  city  should 
call  upon  one  of  the  oldest  and  most  influential 
man  in  the  city,  and  obtain  his  consent  to  the 
calling  of  a  meeting  at  the  Medical  college,  the 
town  hall,  or  even  at  the  residence  of  the  lead- 
ing physician  for  a  certain  evening.  A  printed 
post  card  announcing  the  fact  is  then  sent 
out  to  each  practitioner  within  a  radius  of 
several  miles.  The  appointed  hour  arrives  ; 
only  a  small  proportion  of  the  invited  ones  put 
in  an  appearance  at  the  appointed  hour ;  a  few 
more  drop  in  later.     All  the  others  are  waiting 


44 


THE  CANADA  MEDICAL  RECORD. 


to  see  how  it  will  turn  out.  They  are  the 
selfish  ones  who  want  some  one  else  to  do  all 
the  work,  and  they  will  come  in  later  to  eat  the 
honey  which  the  busy  bees  have  gathered.  Do 
not  wait  for  them,  but  go  ahead  ;  if  there  are 
only  three  present,  elect  one  President,  the 
second  Secretary  and  the  t'lird  Treasurer  ;make 
the  fee  one  dollar  a  year  to  begin  with,  for- there 
are  some  medical  men  who  cannot  understand 
that  one  hundred  dollars  a  year  would  not  be 
loo  mu(  h  to  pay  for  the  benefits  they  would 
get  from  such  a  socii^ly,  and  anything  more  than 
one  dollar  a  year  might  keep  some  from  joining. 
After  these  three,  or  as  many  more  as  there 
may  be,  have  organized,  paid  their  fee  to  cover 
postage  of  notices,  and  decided  en  the  date 
and  place  of  future  meetings,  let  them  spend 
an  hour  or  two  in  pleasant  conversation,  each 
one  telling  his  experiences,  and  we  will  pro- 
mise that  they  will  be  sorry  when  the  meeting 
breaks  up.  When  the  Secretary  goes  home,  let 
him  sit  down  while  the  matter  is  fiesh  in  his 
mind,  and  write  out  a  page  or  two  of  a  report 
for  the  Canada  Medical  Record,  and  we  wil] 
promise  an  early  insertion  in  the  best  part  of 
the  journal.  ,  Next  day  the  Secretary  should  call 
upon  the  members,  by  telephone  or  otherwise, 
asking  them  to  promise  to  show  some  patholo. 
gical  specimens,  living  cases,  or  to  rejjortacase 
or  read  a  paper  at  the  next  meeting,  and  ihoire 
should  be  put  on  the  notice  card  of  next  meet- 
ing. If  a  little  energy  is  put  into  the  matter? 
the  Society  will  be  a  success  from  the  start ;  but 
don't  wait  for  the  doubting  Thomases  to  start 
it.  Begin  with  tliree  members,  and  it  is  bound 
to  grow  until  one-half  the  profession  in  the 
district  has  joined  and  one-fourth  attends 
regularly.  The  MedicoChirugical  Society  of 
Montreal  has  a  membership  of  one  hundred  and 
twenty,  and  an  average  attendance  of  forty.  We 
have  been  told  that  what  has  wrecked  several 
such  societies  is  the  question  of  a  tariff.  If  such 
Is  the  case,  pass  a  resolution  at  the  first  meeting 
that  this  question  must  not  come  up  for  discus- 
sion. It  has  no  business  at  a  scientific  meeting, 
and  had  better  be  discussed  elsewhere.  Also 
pass  a  resolution  that  no  charges  against  mem- 
bers can  be  made  before  the  Society,  but  only 
before  the  council.  This  will  avoid  acrimony, 
and  one  of  the  greatest  benefits  of  medical  socie 
ties  is  the  fostering  of  a  friendly  feeling  between 
the  brothers  of  the  same  profession.     C)ur  sp.ice 


being  limited  we  cannot  say  more  at  present,  but 
we  trust  that  what  we  have  said  will  lead  to  the 
formation  during  the  next  month  of  at  least  a 
dozen  societies  whose  reports  will  find  a 
welcome  place  in  the  columns  of  the  Canad.a. 
Medk'ae  Record. 

THE  KXAMINATION    OF   PATHOLOGI- 
CAL SPECIMENS. 

Every  medical  practitioner  is  or  ought  to  be 
able  to  make  an  examination  of  urine  for  iugar, 
albumen,  bile,  renal  casts,  pus,  mucus.  But 
when  it  comes  to  the  microscopical  examina- 
tion of  tissue^;,  very  few  have  the  necessary 
skill  or  apparatus  to  do  it  properly.  A  well 
known  practitioner  in  this  city  recently  went 
to  New  York  for  the  purpose  of  placing  him- 
self under  the  instruction  of  one  of  the  leading 
pathologists  of  that  city.  The  first  question 
that  the  microscopical  expert  asked  was  • 
"  How  much  time  each  day  will  you  be  able  to 
devote  to  this  work  .^"  The  reply  was  :  ''On 
some  days  an  hour,  on  others  half  an  hour,  while 
during  a  busy  spell  no  time  at  all  for  a  week  or 
longer."  "  Then,  "  said  the  pathologist,  "  it  is 
wasting  time  to  do  such  work  a-t  all,  for  profici- 
ency can  only  be  maintained  by  spending  several 
hours  a  day  at  the  work  alone.  It  is  better  to 
give  your  specimens  to  some  one  who  does 
nothing  else."  How  fiir  he  is  right  we  are  un- 
able to  say  ;  but  there  is  no  doubt  that  many 
practitioners  and  even  Ojierators,  who  would 
like  to  be  scientific  in  their  work,  are 
greatly  handicapped  by  the  want  of  some 
prompt  and  reliable  means  of  having  their 
])athological  specimens  examined.  It  is  with 
great  pleasure  we  read  in  the  University  (of 
Pennsylvania)  Medical  Magazine  that  that  great 
institution  has  arranged  for  this  service.  Any 
physician  has  only  to  send  in  his  specimen  with 
an  exjilanatory  letter,  and  if  his  patient  is  able  to 
pay,  the  sum  of  five  dollars  is  charged  ;  while,  if 
he  simply  states  in  his  letter  that  his  patient  is 
l>oor,  the  specimen  will  be  carefully  examined 
and  a  report  furnished  free  of  charge.  This 
has  already  been  done  by  Dr.  Williams  of 
Johns  Ho]  kins  at  Baltimore,  with  the  result  that 
in  many  cases  he  has  thus  found  some  rare 
and  very  interesting  conditions  ;  and  as  in  many 
cases  he  is  allowed  to  keep  the  specimen,  his 
pathological  museum  has  been  greatly  en 
ri(  lied.     C'ould   not  our    own  qreal    Canadia 


THE   CANADA.   INIEDICAL   RECORD. 


45 


University  of  McGill,  with  its  endowed  Pro- 
fessor of  Pathology  and  its  costly  laboratory  and 
corps  of  trained  assistants,  do  as  much  ?  If 
done  at  all  it  would  have  to  be  done  conscien- 
tiously and  without  favor  ;  for  if  the  specimen 
is  burked,  and  no  more  heard  of  it,  unless  it  be 
sent  by  one  of  the  Faculty,  outsiders  would 
soon  lose  confidence  and  cease  to  send  them. 
Many  surgeons  throughout  the  Dominion 
would,  we  are  sure,  be  glad  to  avail  themselves 
of  such  a  privilege,  the  granting  of  which  we 
hope  ere    long  we   will  be  able  to  announce. 


THE  DEATH  OF  OLIVER  WENDELL 
HOLMES. 

SELECTED. 

The  genial  "  Autocrat"  passed  away  on  Sun- 
day. October  7,  at  the  ripe  age  of  85. 

He  will  be  missed  not  only  by  his  circle  of 
friends  in  Boston,  the  pupils  whom  he  led 
through  the  dreary  details  of  anatomy  for  so 
many  years,  and  the  Massachusetts  Medical 
Society,  but  the  older  members  of  the  Ameri- 
can Medical  Association,  who  remember  with 
pride  that  Doctor  Oliver  Wendell  Holmes 
was  one  of  the  founders  of  the  Association,  and 
at  the  first  annual  meeting,  as  Chairman,  read 
the  "  Report  of  the  Committee  on  Medical 
Literature."  *  In  wliat  more  competent  hands 
could  such  a  report  have  fallen  ?  The  old  mem- 
bers recall  with  affectionate  remembrance  his 
scholarly  articles  read  at  the  earlier  annual 
meetings,  "  On  the  Microscopic  Anatomy  of 
Bone,"  t  "  Puerperal  Fever  as  a  Private  Pes- 
tilence,'' I  and  the  three  Boylston  Prize  Es- 
says. There  are  but  few  now  who  remember 
him  as  he  was  in  his  earlier  days,  and  those 
think  with  him  of  many  a  companion  of  those 
days : 

"  The  mossy  marbles  rest 
On  the  lips  that  he  has  prest 

In  their  bloom  : 
And  the  names  he  loved  to  hear 
Have  been  carved  for  many  a  year 

On  the  tomb . " ' 

The  whole  world  not  less  than  the  medical 
profession  owes  a  deep  debt  of  gratitude  to  him 
for  the  keen  words  of  wisdom  contained  in  his 
essay  on  the  cause  and  prevention  of  puerperal 
sepsis,  written  thirty  years  before  the  era  of 
antiseptic  douches  and  precautionary  cleanli- 
ness. The  many  suggestions  contained  in  the 
valedictory  address  to  the  graduating  class  of 
Bellevue  Hospital  Medical  College  in  187 1 
conveyed  in  his  inimitable  manner  to  medical 
men  generally  rules  for  social  and  professional 

*  Transautions,  Vol.  i,  jj.  249. 
t  Transactious,  Vol.  iv,   p.  52. 
i  Transactions,  Vol,  ix,  p.  37'.'. 


conduct,  so  valuable  that  they  deserve  perennial 
reproduction.  His  "  Lectures  on  Homcjeopathy 
and  Kindred  Delusions"  abound  with  that 
keen  humor  characteristic  of  his  bright,  viva- 
cious spirit ;  but  even  in  satire  he  always  avoi- 
ded needless  pain  and  severity.  He  never 
wrote  anything  which  could  cause  him  to  be 
classed  among  those  writers  of  whom  he  wrote: 
"Their discords  sting  through  Burns  and  Moore, 
Like  hedgehogs  dressed  in  lace." 

As  a  medical  teacher  he  invested  even  the 
most  intricate  details  with  a  polish  which  was 
not  merely  veneer,  for  no  one  could  have  heaid 
his  famous  dedication  address  at  the  opening 
of  the  Boston  Medical  Library  without  knowing 
that  his  wide  knowledge  of  medical  literature 
was  one  acquired  not  only  by  reason  of  years 
of  love  of  the  subject,  but  by  hard  and  ]iains- 
taking  labor.  The  class  of  1847  ^^^  heard 
Dr.  Holmes'  lectures  on  anatomy  at  Harvard 
University  were  astonished  and  delighted  by 
his  methods  and  pleasant  manner,  and  annu- 
ally thereafter,  for  nearly  or  quite  thirty  years. 
Professor  Holmes  appeared  before  the  class 
with  military  promptness. 

We  have  not  mentioned  him  as  he  appears 
to  the  literary  world,  for  all  the  world  is  in 
mourning  for  him  to-day,  and  his  greatness  in 
general  literature  has  made  his  writings  familiar 
to  thousands  of  old  and  young  readers,  who 
have  probably  learned  for  the  first  time, by  read- 
ing the  obituary  notices,  that  he  was  a  physician. 
He  was  not  only  a  physician  in  every  sense  of 
the  word,  but  a  great  physician,  and  one  whose 
researches  and  observations  would  have  made 
him  famous  had  he  never  written  a  liie  of  his 
illustrious  prose  and  poetical  works. 

'1  here  is  grief  in  the  Massachusetts  Med- 
ical Society,  because  he  is  no  more,  and  many 
an  eye  will  become  dim  with  tears  when  his 
empty  chair  is  placed  at  tlie  annual  dinner  table. 

In  the  album  of  a  young  lady,  tiien  at  Bar 
Harbor,  there  was  written  by  Dr.  Plolmes  in 
his  old  age,  the  following,  which  shows  to  what 
thoughts  his  mind  was  tending  in  his  last  days  : 

"  From  this  fair  home  behold  on  either  side, 
The  restful  mountains  or  the  restless  sea ; 

So  do  the  warm  sheltering  walls  of  life  divide 
rime  and  its  tides  fiom  still  eternity. 

"  Look  on  the  waves,  their  noisy  voices  teach 
That  not  on  earth  may  toil  and  struggle  cease  ; 

Look  on  the  mountains,  better  far  than  speech, 
Their  silent  promise  of  eternal  peace." 

— -Journal  Am.  Medical  Association. 

AMERICAN  PUBLIC  HEALTH 
ASSOCIATION. 

The  published  transactions  of  this  Associa- 
tion, extending  over  a  quarter  of  a  century, 
constitute  a  library  of  sanitary  science  full  of 
])romise  for  the  future.  The  Montreal  meeting 
of  the  Association  last  week  adds   another  vo- 


46 


THE   CANADA   MEDICAL  RECORD. 


liime  of  increasing  interest.  The  membership 
includes  all  the  leading  health  officers  of  both 
cities,  States,  and  the  governments  of  United 
States,  Canada  and  Mexico,  also  of  the  Army 
and  Navy  of  these  countries.  It  also  includes 
sanitary  engineers  and  plumbers,  and  officers 
who  are  dealing  with  questions  affecting  public 
health.  From  this  the  wide  and  varied  character 
of  the  papers  may  be  inferred.  At  this  meetini; 
sixty-one  papers  were  read,  and  eight  reports  of 
the  progress  of  science  on  special  topics;  to- 
gether with  one  evening  devoted  to  addresses 
of  welcome  and  commendation. 

A  grand  excursion  to  the  Quarantine  at 
Grosse  Isle  on  the  St.  Lawrence,  below  Quebec, 
also  a  ride  through  La  Chine  Rapids,  and  a 
reception  were  given  to  the  members.  Outside 
of  this,  four  days  were  devoted  to  the  real  work 
of  reading  and  discussing  the  many  topics. 

As   usual   in    all    such    meetings,  a   certain 
number   of  papers    are  poor   compilations    of 
books  and   jjamphlets,  and  a   certain   number 
contain  a  few  facts  of  fresh  interest,  that  could 
be  stated  in  a  few  printed  lines,  but  are  covered 
up  in  words  that  stretch  over  twenty  minutes. 
A  small  number  of  papers  are  always    extreme 
in     assumption,  and     dangerously    dogmatic, 
and  other  papers    seem    to  come    up  to    the 
verge  of  originality,   but   fail  in   obscurity  and 
confusion  of  statement.     Then    the  usual  ad- 
vertising and  commercial  papers    and  the  en- 
thusiast with  one  idea  and  one  theory  to  apply 
to   all  conditions  of  life  and    living.     Beyond 
this  common  experience  of  eveiy  meeting,  some 
excellent  scientific  work  was  presented.     The 
filtration  and  sedimentation  of  water  was  pre- 
sented with  great  clearness,    and  the  results  of 
original  expe:iments  given,  showing   that  pol- 
luted waters  passing  over  sand  beds  maybe  de- 
prived of  95  per  cent,  of  all  their  microbes  and 
organisms.     The  efforts  to  extend  the  bounda- 
ries   of  exact  science    in  this    direction    were 
very   clearly    set    forth   by  Dr.  Smart,  of  the 
U.  S.  Army,    in  a  report  on    this   topic.     The 
disposal  of  garbage  was  the  topic  of  several  ex- 
cellent pai)ers,  showing  great  advance  and  very 
thoughtful    suggestive  work  in  this  field.     The 
air  and  water  of  farm  houses  was  the  subject  of 
sorne   striking   observations.     Car  ventilation, 
the  danger  from  sputa  in  tuberculosis,  and  the 
infection   of  milk  from  tuberculosis  were  well 
presented.     "The  Influence  of  the  Climate  of 
Canada  on   Health,"     "The  Influence  of  Ine- 
briety on  Public   Health,"  and  the  "  Long  Is- 
land   Water    Basin,"    were     notable    papers. 
Drainage,    ventilation,     cremation,    i)lumbing, 
climate,  and  other  topics    received  very  sub- 
stantial contributions.     The  fact  that  over  four 
hundred   members   were     registered   from    all 
parts  of  the  United  States,  Canada  and  Mexico 
is  signifiraiit    of  n     great  ndv.nnci'  in    sanitary 
matters. 


The  science  of  medicine  has  expanded  to 
such  an  extent  that  these  widely  varying  topics 
must  be  separated  and  studied  by  specialists. 
As  in  all  new  subjects,  sanitary  science  and 
the  questions  of  the  pre,vention  of  disease  must 
pass  through  the  various  stages  of  growth  and 
evolution. 

Health  boards  with  their  officers  and  inspec- 
tors should  lead  as  teachers    and  instructors  of 
])ubHc   sentiment;    while    the   general    practi- 
tioner may  be  a  good  observer  and  reasoner  of 
causes  and  effects    in  preventive    medicine,   he 
can  not  have  the  experience   and  facts  to   draw 
conclusions  from  that  health  boards  possess. 
Yet  the  impression  grows  stronger  after  listen- 
ing to  a  long  list  of  papers    by  men  who   are  in 
a  position  to  know  the  facts,  that  many  of  these 
sanitarians   fail  to    use    the  knowledge  in    their 
possession,    or  to    make  the   original  observa- 
tions possible    in  their    positions.     A  little  re- 
flection makes   it  apparent   that  many 'persjns 
connected    with  these   health  boards  owe  their 
positions  more  to  political  influence    than  to 
scientific   attainments.     This  readily  -explains 
the  disappointment  in  the    character  and  qual- 
ity   of  some    of   the   work   of    these    boards. 
While  the  blighting   influence  of  politics    is  not 
peculiar  to  boards  of  health   and  sanitarians  in 
general,  yet  it  can   be   seen  and  felt  in  many 
ways  in  all  these  gatherings.     This   meeting  of 
the  Association    showed  a   marked  advance  in 
many  ways,  over  previous  gatherings,  and  will 
be  noted  in  its  history  as  the  starting  point   by 
the  publication  of  its  transactions  in  a  quarterly. 
These  large  gatherings  of  men  devoted  to  sani- 
tary   subjects    have   an  excellent    influence  on 
the  public,  and  if  the  rule   of  the   .Association 
was  rescinded   so  as  to    allow  daily  papers   to 
publish  certain  papers  in    full,  the  best   results 
would  follow,  and  more  good  would  be  done. 
Over    a   dozen    papers   read    at    this  meeting 
would   have   been  printed  in  full  by   the  daily 
press,  and  read  by  a  large  number  of  persons  to 
their  great  profit,  if  the  rules  could  have  been 
changed.     As  it  is,  these  papers  will  be  buried 
in  the  transactions  and  only  a  few  ever  appear 
in   the  public   press.      The   sanitarians  of  this 
country  have  a  great  field  before  them,  and  this 
Association   is  doing  a  work  of  very   wide   in- 
fluence.—  The  Journal  Am.  ^fe^/.Assn. 

THE     AMERICAN      ELECTRO-THERA- 
PEUTIC ASSOCIATION. 

This  Association  held  its  fourth  annual  meet- 
ing in  New  York  City  September  25,  26  and  27, 
under  the  presidency  of  Professor  W.  J.  Herd- 
man,  of  Ann  Arbor.  The  scientific  proceed- 
ings, which,  we  presume,  will  appear  in  full  in 
\\\^  Journal^  were  more  than  usually  interesting 
and  systematic,  the  plan  of  jire-arranged  dis- 
cussions on   the   physics    and  theia[ieutics  of 


THE  CANADA  MEDICAL  RECORD. 


47 


each  ronu  of  cuircnt  being  folluA'cd.  The 
spirit  of  the  meeting,  which  was  largely 
attended,  seemed  to  be  the  discussion  of  tlie 
primary  facts  of  electro-physics  and  their  ap- 
plications to  medicine,  and  while  but  few  new 
facts  were  announced,  the  full  discussions 
elicited  on  these  fundamentals  were  interesting 
alike  to  the  expert  and  the  tyro,  and  can  not 
be  other  than  highly  useful  in  stimulating 
greater  accuracy  and  thoroughness  in  the 
medical  users  of  electricity.  The  presence 
and  participation  of  a  number  of  electrical  en- 
gineers and  distinguished  physicists  were  sig- 
nificant. 

On  the  evening  of  the  third  day  the  members 
were  received  by  Nikola  Tesla  at  his  labora- 
tory, and  were  treated  to  a  display  of  the  re- 
markable qualities  of  high  frequency  currents 
recently  developed  by  this  latest  electrical 
prodigy.  On  Friday,  through  the  courtesy  of 
Mr.  Edison,  the  whole  Association  and  its 
ladies  were  conveyed  to  Edison's  laboratory 
by  special  train,  and  escorted  through  the 
works,  after  which  a  delightful  banquet  was 
enjoyed. 

That  New  York  fulfilled  its  social  opportun- 
ities was  well  proven  by  the  reception  and 
banquet  at  the  Academy  of  Medicine,  and  by 
its  private  hospitalities  to  visiting  members. 
— The  Journal  Am.  Med.  Assn. 


BOOK  NOTICES. 

The  Year-Book  OF  Treatment  for  1894.     A 
comprehensive     and   critical     review     for 
practitioners  of  medicine  and  surgery.     By 
twenty-four   eminent   specialists.      Duode- 
cimo,   497    pages.      Cloth,   $1.50.      Lea 
Brothers  &   Co.,    medical  publishers,  706 
708  and  710  Sanson!  St.,  Philadelphia. 
The  great  value  to    every   practitioner  and 
specialist  of  having  at  hand   such   a    volume 
must    be  obvious.     It  covers    the  advances  in 
treatment  made  in  all  departments  of  medicine 
and  surgery,  including   all    the   specialties  dur- 
ing the   preceding  twelvemonth.     The   various 
articles   are    sufticiently    detailed  for   practical 
purposes,  but  full  references    to  original  papers 
are  given  for  the  convenience  of  those  desiring 
to   make   extended   research.     The  volume   is 
completed  with  a  selected  list  of  new    books, 
etc.,  an    index  of  authors,    and   an   index   of 
subjects.     In  combination  with  the  American 
Journal  of  tfie  Medical  Sciences  (monthly,  $4.00 
per  annum),   or    Ike   Medical  News  (weekly, 
$4.00  per  annum),  or  both  ($7.50  per   annum). 
The  Year-Book  of  Treatment    is  placed   at  75 
cents.     IVis  Year-Books  of  Ireatmentiax  1891, 
1892  and  1893  can  be  obtained  for  Si. 50  each, 
and    the   issues   for    18S6  and    1887  for  $1.25 
each. 


Tni',  RtTRO.srEci'OFl'RA^  I'icAL  Medicine  and 
Surgery.     Being     a    half-yearly    journal 
containing  a    retrospective  view    of  every 
discovery   and  practical    improvement    in 
the   medical  sciences.     Edited    by    James 
Braithwaite,  M.D.  London,  obstetiic  phy- 
sician    to    the     Leeds    General      Infirm- 
ary ;      late      Lecturer    on     Diseases      of 
Women  and  Children,    Leeds    Schojl   of 
Medicine  ;   Fellow  and     late   Vice-Presi- 
dent of  the  Obstetrical  Society  of  London; 
Corresponding     Fellow    of    the      Gynae- 
cological Society  of  Boston,  U.S.    Volume 
CIX.,    July,    1894.     Uniform    American 
edition.    New  York:  G.  P.  Putnam's  Sons, 
27  West  Twenty-third  Street  ;   1894.     For 
sale  by  Dawson  Brothers,  Montreal,  $2.50 
a  year  in  advance,  half-yearly  parts  $1.50. 
We  are    always    glad    to    welcome    Braith- 
waite  to  our  library  table.     The    articles    are 
as     usual     well     selected     and     the  abstracts 
very    concise     and   clear.     It   is    well    worth 
the  price  for   the  physician    to    have  it    in  his 
carriage   or  while  waiting  at  a  case,  being   full 
of  hints  of  practical  value. 


PAMPHLETS. 

Practical  Application  of  the  Principles 
OF  Sterilization.  By  Hunter  Robb, 
M.D.,  Associate  in  Gynaecology,  Johns 
Hopkins  University,  Baltimore.  Re- 
printed from  the  American  Journal  of  Ob- 
stetrics, Vol.  XXX,  No.  I,  1894.  New 
York  :  William  Wood  &  Company,  pub- 
lisheis,  1894. 

Can  Physicians  honorably  accept  Commis- 
sions from  Orthopedic  Instrumeni 
makers.  By  H.  Augustus  Wilson,  A.M., 
M.D.,  Professor  of  General  and  Orthope- 
dic Surgery  Philadelphia  Polyclinic;  Clini- 
cal Professor  Orthopedic  Surgery,  Jefferson 
Medical  College. 

Intraligamentous  and  Retroperitoneal 
Tumors  of  the  Uterus  and  its  Adnexa. 
By  William  H.  Wathen,  A.M.,  M.D. 

A  Week's  Work  in  Gynecology.  By  Ken- 
neth N.  Fenwick,  M.A,  M.,D. 

Diagnostic  Palpation  of  the  Appendix  Ver« 
miformis.  Cases  of  Appendicitis.  By 
George  M.  Edebohls,  A.M.,  M.D.,  Gynae- 
cologist to  St.  Francis  Hospital,  New 
York  J  Professor  of  Diseases  of  Women 
at  the  New  York  Post-Graduate  Medical 
School  and  Hospital.  Reprinted  from  the 
American  Journal  of  the  Medical  Sciences. 
May,  1894;  The  Post-Graduate,  April, 
1894  ;  and  the  New- York  Journal  of  Gynae- 
cology   and    Obstetrics,    February,    1894. 


48 


THE  CANADA  ^^lEDICAL  RECORD. 


Pregnancy  aitlr  \'tiMRAL  Tixation  ok  ihe 
Uterus.  A  Report  of  Four  Cases.  By 
George  M.  Edebohls,  A.M  ,  M.D.,  Gynae- 
cologist to  St.  Francis  Hospital,  New  York  : 
Professor  of  Diseases  of  Women  at  the  New 
York  Post-Graduate  Medical  Scho  il  ;  Con- 
sulting Gynfecolugist  to  St.  Jcjhn's  River- 
side Hospital,  Yonkers,  N.Y.  Reprinted 
from  the  Tran.«actions  of  the  New  York 
Obstetrical  Society. 

Morphinism  in  Medical  Men.  Read  before 
the  American  Medical  Association,  San 
Francisco,  6th  June,  1894.  By  J.  B.  .Mat- 
tison,  M.D.,  Medical  Director  JJrooklyn 
Home  for  Habitii6s. 

The  Modern  and  Humane  Treatment  of  the 
Morphine  Disease.  By  J.  B.  Mattison, 
M.D.,  Medical  Director  Brooklyn  Home 
for  Habitues.  Read  before  the  Pan-Ameri- 
can Medical  Congress,  Washington,  D.  C, 
6th  September,  1893.  Reprint  from  Medi- 
cal Record,  December  23rd,  1893. 

De  l'AgrandissementMomentane  du  BaSSIN' 
Rapport  111  an  Congres  International  des 
Sciences  Medicales  tenu  a  Rome  du  29 
Mars  au  5  Avril  1894.  Par  Adolphe  Pinard, 
Professeur  a  la  Faculte,  Membra  de  I'Aca- 
demie  de  Medecine,  Paris.  G.  Steinheil, 
editeur   2,    rue  Casimir-Deiavigne.     1894. 

Annual  Announcement  of  Trinity  Medical 
College,  Toronto,  established  1850,  incor- 
])orated  by  special  Act  of  Parliament.  In 
aftiliaiion  with  Trinity  University,  The  Uni- 
versity of  Toronto,  Queen's  University 
and  the  University  of  Manitoba  ;  and  speci- 
ally recognized  by  the  Royal  College  of 
Surgeons  of  England  ;  the  Royal  College 
of  Physicians  of  London  ;  the  Royal  Col- 
leges of  Physicians  and  Surgeons  of  Edin- 
burgh ;  the  Faculty  of  Physicians  and  Sur- 
geons of  Glasgow  ;  the  King's  and  Queen's 
College  of  Physicians  of  Ireland,  and  by 
the  Conjoint  Examining  Boards  of  London 
and  Edinburgh.     Session  1894-5. 

The  Spelling  of  some  Medical  W^irds.  By 
George  M.Gould,  A.M. ,  M.D.,  of  Phila- 
delphia, Pa.  From  The  Medical  News, 
*  June  17,  1893. 


CLASSROOM  NOTES. 

— Prof.  Parvin  says  in  cases  o{ Rupture  of  the 
Uterus,  when  it  has  become  necessary  to  per- 
form laparotomy  in  oider  to  deliver  the  child, 
and  hemorrhage  exists  which  cannot  be  con- 
trolled by  either  sutures  or  tam[)ons  of  iodo- 
form gauze,  hysterectomy  is  indicated. 

—  Prof.  Parvin  says  one  of  the  best  methods 
of  getting  rid  of  the  accumulation  of  water  tliat 
occuis  in  cases   of  Ilydrcemia   is  by  giving  the 


patient  a  hot  bath  for  about  twenty  minutes  and 
hen  giving  her  a  glass  of  hot  water  to  drink, 
causing  her  to  perspire  freely. 

— Prof.  Parvin  says,  if  immediately  after  the 
birtii  of  tiie  ciiild  the  after  pains  are  so  severe 
as  to  prevent  the  mother  from  sleeping,  and  are 
not  relieved  by  the  application  of  hot  com- 
presses to  the  uterus,  with  compression  of  the 
uterus,  opium  and  camphor  or  antipyrine  may 
be  administered. 

— Atropine  and  Belladonna  exert  their  chief 
influence  on  blondes. 

— Prof.  Hare  says  Chronic  Catarrh  of  the 
Mucous  Membrane  is  often  relieved  by  alkaline 
diuretics. 

— Dr.  Wolff  does  not  favor  the  use  of  the  cold 
baili  in  the  treatment  oi  Pneumonia,  for  the 
reduction  of  the  fever. 

—  Prof.  Parvin  believes  that  women  who  de- 
velop a  goitre  during  their  pregnancy  should 
not  nurse  the  child. 

— Prof.  Parvin  says  that  the  period  of  incu- 
bation of  Scarlet  Fever  is  longer  in  a  pregnant 
than  in  a  non-pregnant  woman. 

— Prof.  Hare  says  creosote  should  not  be 
employed  in  cases  of  Tuberculosis  in  which 
hemorrhage  or  hectic  fever  is  present. 

— In  cases  of  Intestinal Flatulenee  combined 
with  indigestion,  Prof.  Haie  says  chloroform 
will  be  found  to  be  very  valuable. 

— Prof.  Parvin  says  a  nervous  woman  is 
more  predisposed  to  Puerperal  Convulsions 
than  one  whose  nervous  system  is  not  over-sen- 
sitive; 

— In  cases  where  a  tumor  of  the  breast  oc- 
curs, accompanied  by  a  retraction  of  the  nip- 
ple. Prof.  Keen  says  that,  as  a  rule,  the  tumor 
is  a  Carcinoma. 

— Prof.  Keen  says  in  Cancer  occurring  in 
the  breast,  the  whole  breast  should  always  be 
removed,  on  account  of  the  infiltrating  method 
in  which  a  cancer  grows. 


PUBLISHERS  DEPARTMENT. 

At  the  Antwerp  Exposition,  Wm.  R.  Warner  6^  Co. 
were  awarded  the  Grand  Prize  for  the  excellence  ami 
purity  of  their  preparations. 


WAsniNr.TON,  D.C.,  Sept.  ii.  1894. 

Genile.men  :  — 

I  desire  to  thank  you  for  sampVe  of  the  drug,  often  but 
poorly  imitated,  made  by  your  firm,  and  known  as 
"  Anlikamnia." 

The  adoption  of  the  monogram  on  the  new  tablets  and 
tlie  recall  of  all  the  old  stock  from  the  market  will  prove 
of  benefit  to  you  and  the  many  physicians  who  may 
heieafler  desire  lo  atTord  relief  by  its  use. 

Yours  respectfully. 

C   1:.  I'OSTLKV,   M.l)., 

1429  I  ith  St.,    N.W 
Tn  TiiK  Antikamnia  Chkmicai.  Co.. 
Sr,  Luuis  Mo. 


Vol.  XXIII. 


MONTREAL,  DECEMBER,   1894. 


No.  3. 


ORIGINAL  COMMUNICATIONS. 

CoiMine  I'oisoninu         4<) 

SOCIETY  PROCEEDINGS 

The     Jlontreal    Medico-Cliirurgioal 

Society ",    ...  51 

(Jhlorofdi-m  Accident ni 

The  late  I  >r.  Fen  wick   5i! 

Annual  iMeetiiijii; ,5'2 

Annual  AiUli-ess     r>:i 

KU'Vfnth      International      Medical 

Congress ..54 

Treatment  of   JJlennorrhagic    Ure- 

thrilis  in  the  Female 54 

Alumnol  in  the  Treatment  of  Blen- 

norrhagia    54 

Kadical  Cure  of  Einthelial  Cancer 

of  the  Skin 55 

Indications   and   Limits  of  Topical 

Treatment  in  Laryngeal  Phthisis.  .W 

Vienna  :\ledical  Society.        .    55 

Vasomotor  Phenomena  in  Fever ....  .55 

Treatment  of  Laryngeal  Phthisis.  5G 

Berlin  Medical  Society 5G 

Kesection  of  the  Intestine 56 

PROGRESS  OF  SCIENCE- 

Onterbridge's   Operation    for    Hem- 
orrhoids      5G 


OOZSTTEISTTS- 

Salol  in  Diarrluea   ... 

Ituptiired  Gastric  Ulcer  successfully 
treated  liy  Alidominal  Section  anil 
Suture    

The  Antitoxin  Treatment  of  Diph- 
theria    

The  Cause  and  Percentage  of  Myo- 
l)ia 

A  Novel  Way  of  giving  an  Kntuua. 

Lowered  Duties  on  Drugs 

A  Successful  Warfare  

Medical  Opinion  as  to  the  Use  of 
Opium  among  the  Chinese  

Five  Cases  of  CoiiorrlKca  In  Little 
Cirls 

In  Dermatology   ... 

In  Otology 

Tippling   

Septicienna  during  Scarlet  Fever, 
implicating  several  .joints  and  caus- 
ing Necrosis  of  the  (Clavicle 

Foreign  Body  in  the  ffisophigus     . . 

Ignipuncture  in  Tubercular  Arthritis 

Suppuration  of  the  INliddle  Ear  due 
to  a  Coffee  Be  ni  in  the  Nose  

The  Method  of  Brand  in  the  Treat- 
ment of  ryi)hoid  Fever 

Nitrate  of  Strychnine  in  Alcoholism 

Tic  Douloureux 

A  Bloodless  Operation  for  Hemorr- 
hoids       


EDITORIAL. 

Who  owns  the  Doctor's  Prescription.  (!7 

'I'he  Aiurpliy  Button   GS 

'I'he  Anti-ToxineTreatmentof  Diph- 
theria         OS 

Post-Graduate  Instruction  in  .M(Mit- 

real   C'J 

The  Caiadian  Medical  Beview  Gl) 

The  Canadian  Medical  Monthly 69 

.'V  Generous  Bequest 09 

Bishop's  College   70 

BOOK  NOTICES. 

Travaux  d'Eleetr  ithrrapie  Gyniteo- 

logi(iue   70 

Tlie  I'ocket  Anatomist   70 

Syllabus  of  Lectures  on  Human  Em- 
bryology    70 

Practical    Urinalysis    and    Urinary 

Diagnosis      ...         71 

Text-Book  of  Hygiene   71 

A  Famous  Show"  of  Beauty   71 

Saunders'  New  .\id  Series   71 

Pamphlets  received 72 

Publishers'  Department   72 


|rigfnal    j^^omimintcalions. 


COCAINE    POISONING. 

By  J.   B.   Mattison,  yi.V>.,  Medical  Dir- 
ector,   Brooklyn  Home  for  Habitues. 

It  is  "  ancient  history "  more  or  less 
since  the  writer  began  to  pre.-^ent  the  record 
of  toxic  effects  from  cocaine. 

During  the  nearly  nine  years  past- 
dozens  of  deaths  and  hundreds  of  non-fatal 
cases  from  untoward  effect  of  this  drug 
have  been  placed  before  the  profession,  so 
that  one  is  at  a  loss  to  know  whether  he 
who  at  this  late  day  says,  "  it  has  hardly 
been  reasonable  to  call  it  a  poison  in  any 
ordinary  quantity,"  is  ignorant  of  this 
toxoemia,  or  is  blinded  by  a  feeling  in  its 
favor  that  prompts  him  to  question  this 
fact,  and  prevents  him  counselling  that 
caution  in  its  use  which  prudence  un- 
doubtedly demands. 

A    Boston  oculist,  Dr.    J.    A.    Tenney, 

*  Read  before  the  Kings  County  Medical  Society,  Oclo 
ber  i6th,  1894. 


writing  recently  a.bout  "  mishaps  with  co- 
caine," used  the  language  we  have  quoted, 
and  in  so  doing  may  have  intended  to  limit 
his  statement  regarding  its  non-toxic  effect 
to  his  special  field.  If  so,  he  might  better 
have  been  more  explicit,  for,  surely  it  was 
not  wise  to  disclaim,  in  a  general  way,  its 
power  as  Tipoison,  for  poison  it  truly  is. 

In  November,  1886,  at  a  meeting  of  the 
New  York  Neurological  Society,  Doctor 
William  A.  Hammond,  speaking  of  cocaine^ 
said  "he  did  not  believe  any  dose  that 
could  be  tikn  was  dangerous."  Before 
that  meeting  ended,  the  writer  challenged 
such  a  dangerous  statement,  and  warned 
the  members  against  accepting  it,  and, 
during  the  next  year,  presented  such  con- 
vincing proof  tliat  Hunmondwas  wrong 
as  to  iiTii)elthe  British  Medical  Journal  to 
assert,  editorially,—"  if  it  were  more  need- 
ful to  produce  more  pro  )f  of  the  unsound- 
ness of  Dr.  Hammond's  opinion.  Dr.  Matti- 
son has  effectuilly  done  this." 

Dr.  Hammond  has  lived  to  see  the  day 
that  he  regrets,  quite  likely,  having  ex- 
pressed   such    dangerous    doctrine.       He 


50 


THE  CANADA  MEDICAL  RECORD. 


certainly  has   admitted    his  error,  for,    in 
discussing  my  paper  on  cocaine  inebriety 
read  before  the  District  of  Columbia  Medi- 
cal Society,  Washington,    Christmas  Eve^  ' 
1 89 1,  he  frankly    confessed   that    he   was  ; 
wrong,  and    avowed    that  //c    had  nearly 
killed  a  patient  with  cocaine. 

No  one  can  tell  what  mischief  went  in 
the  wake  of  his  expressed  disbelief  in  the 
toxic  power  of  this  drug.  Had  it  come  , 
from  some  obscure  practitioner,  it  would 
have  passed  almost  unnoted,  but,  with  the 
weight  of  such  authority  as  Hammond's 
professional  prominence  gave  it,  it  was  all 
the  more  dangerous. 

The  first  lethal  case  of  cocaine  poisoning 
was  due  to  the  hapless  surgeon's  reliance 
on  its  asserted  use  in  large  amount  with- 
out harm.  This  case  had  a  doubly  tragic 
ending,  for,  not  only  did  it  cost  the  life  of 
the  patient,  a  young  woman,  but  the  un- 
happy surgeon,  overcome  by  regret  or 
remorse,  committed  felo  de  se. 

What  the  outcome,  fatal  or  non-fatal — 
all  unrecorded,  it  may  be — of  a  like  reli- 
ance on  Dr.  Hammond's  statement  ? 

Dr.  Tenney  seems  to  think  that  the  tak- 
ing of  18  grs.  of  cocaine,  subcutaneously, 
in  3  doses,  at  short  intervals  without 
death — which  was  Hammond's  claim — 
proves  it  hardly  reasonable  to  call  it  a  poison. 
We  do  not  agree  with  him.  It  simply 
proves  an  exception  to  a  rule  just  such  as 
obtains  along  numberless  other  lines  ;  and, 
in  view  of  what  history  has  given  us  con- 
cerning cocaine  poisoning,  it  proves  that 
it  was  a  fool-hardy  affair,  for  it  might  have 
cost  the  venturer  his  life.  Many  a  man 
ess  a  Hercules  than  Hammond  would 
have  been  promptly  "gathered  to  his 
fathers." 

There  is  little  question  that  the  earliest 
reports  on  cocaine  roused  a  fervor  in  its 
favor  that  led  more  than  one  to  commend 
it  with  a  zeal  not  tempered  by  that  cau- 
tion which  prudence  demands.  Others, 
while  not  lauding  it  unduly,    were  inclined 


to  disparage  the  warning  note  that,  early, 
was  sounded  against  it.  I  well  recall  a 
member  of  the  Neurological  Society,  who 
expressed  himself  as  much  pleased  with 
Dr.  Hammond's  assertion  regarding  the 
non-harmful  nature  of  cocaine,  as  one  likely 
to  lessen  an  unfounded  prejudice  against 
a  valuable  drug. 

With  the  deadly  record  that  has  since 
been  presented,  it  is  quite  probable  that 
member— Leonard  Corning-  has  changed 
his  opinion  ;  for  he  must  know  the 
expressed  fear  of  cocaine  had  a  foundation 
on  fact. 

History  has  repeated  itself  along  lethal 
lines,  as  regards  cocaine,  so  often,  that  it 
really  seems  surprising  that  any  one  at 
this  day  should  question  its  power  for 
harm.  It  may  not  be  known  to  all  that 
cocaine  has  killed  in  smaller  dose  than 
morphine,-  but  that  is  a  fact.  It  may  not 
be  known  to  all  that  cocaine  has  killed  in 
quicker  time  than  morphine, — but  that  is  a 
fact. 

Autumn  before  last,  I  reported,  for  the 
first  time, — through  the  courtesy  of  Doctor 
George  B.  Cushing,  now  of  Wheeling,  W. 
Va. — this  case.  Strong  man  walked  into 
Bellevue  Hospital,  suffering  from  urine 
retention.  Catheter  disclosed  stricture. 
One  drachm  of  a  4  oz.  solution  of  cocaine 
was  thrown  in  urethra.  Almost  at  once 
patient  became  greatly  excited,  and  in  a  few 
seconds  went  into  convulsions  so  violent 
that  it  required  the  combined  strength  of 
doctor  and  nurse  to  hold  him  on  table. 
Amyl  was  promptly  used  ;  no  reaction  ;  in 
4  minutes,  man  was  dead  ! 

This  case-  for  which  I  thank  Dr.  J.  E. 
LumbarJ,  New  York  cit\- — is  now  first 
reported.  Man,  aged  25,  entered  Manhat- 
tan Hospital,  complaining  of  2  days  urine 
retention.  Catheter  revealed  traumatic 
stricture,  due  to  a  2}4  inch  sewing  needle 
put  in  urethra  by  chum,  during  a  drunken 
frolic.  Twenty  minims  of  a  40Z.  cocaine 
solution  were  injected  in  urethra.     Imme- 


THE  CANADA  MEDICAL  RECORD. 


51 


diately,  patient  went  into  convulsions,  and, 
despite  every  effort,  died  !  Autopsy,  in 
each  case,  showed  intense  lung  congestion. 

Very  recently,  two  deaths  from  cocaine 
—  within  a  fortnight  of  each  other — have 
been  noted  and  are  now  first  reported. 

On  the  last  day  of  last  month,  a  young- 
woman  visited  a  "complexion  artist" — 
so  called — in  Chicago,  to  have  a  facial 
blemish  removed.  Sham  electricity  was 
used — it  being,  really,  a  dummy  battery, 
one  sponge  of  which,  saturated  with  a 
strong  solution  of  carbolic  acid,  was  held 
to  the  affected  part,  with  the  result  of 
causing  great  pain.  To  relieve  this,  a  4 
oz.  solution  of  cocaine  was  freely  applied. 
In  a  few  minutes,  the  woman  became 
excited,  said  she  felt  strange,  walked  to  a 
window,  and  fell  dead!   No  autopsy. 

Four  days  ago — Friday  last — a  man, 
aged  26,  entered  the  office  of  a  Jersey 
City  physician,  to  be  operated  upon  for  a 
rectal  fistula.  Twenty  minims  of  a  4  oz. 
cocaine  solution  were  injected  hypodermi- 
cally,  for  anaesthesia.  No  effect  ensuing 
in  10  minutes,  20  minims  more  were 
injected.  In  3  minutes,  the  man  became 
unconscious  and  convulsed.  One  minute 
later  he  was  dead  !  No  autopsy. 

The  evidence  to  prove  cocaine  a  poison 
is  now  so  ample,  that  no  excuse  will  avail 
to  exonerate  the  doctor  who,  not  heeding 
the  lesson  taught  by  the  gruesome  record, 
fails  to  use  it  with  the  care  its  toxic  energy 
demands. 

It  is  a  drug  peerless  for  good  in  certain 
conditions  ;  but  its  power  for  ill  must 
never  be  lost  sight  of,  if  one  would  conserve 
the  best  interests  of  those  on  whom  it  may 
seem  wise  to  use  it. 

Prospect  Place 

near  Prospect  Park. 


J0cict|i     ^roceebtngs. 


THE     MONTREAL     MEDICO-CHIRUR- 
GICAL   SOCIETY. 

Stated  Meeting,  June  29///,  1894. 
James  Bell,  M.D.,  President,  in  the  Chair. 

Dr.  Bell  presented  the  following  specimens: 

(i)  A  large  concretion  which  he  had  recently 
removed  from  the  bowel  in  a  case  of  appen- 
dicitis. The  patient  was  47  years  of  age,  and 
had  a  bad  history  of  recurrent  attacks  at  inter- 
vals of  three  or  four  months  for  the  last  21 
y'=ars.  The  last  attack  occurred  eight  weeks 
before  coming  under  observation,  and  it  was 
then  for  the  first  time  that  he  noticed  any  mass 
in  the  abdominal  wall.  This  mass  was  in  the 
situation  of  the  appendix,  and  about  the  size  of 
a  hen's  egg  ;  it  was  very  hard  and  very  clearly 
adherent  to  the  abdominal  wall,  was  quite  ten- 
der to  the  touch,  and  on  walking  he  suffered  a 
dragging  pain.  Operation  was  advised  and 
accepted  by  the  patient,  and  was  carried  out  in 
the  usual  way.  The  incision  was  made  to  the 
inner  side  of  the  mass,  which  was  then  carefully 
dissccied  away  from  the  abdominal  wall  to 
which  it  was  attached  by  very  firm  adhesions. 
The  free  surfaces  of  the  ccecum  and  the  lower 
end  of  the  ileum  were  found  to  be  adherent, 
and  in  the  adhesions  were  enclosed  in  a  hard 
mass  and  the  base  of  the  appendix.  The  free 
end  of  the  appendix  projected  about  an  inch  and 
a  half  On  separating  the  ileum  and  the  ctecum, 
it  was  found  that  the  greater  part  of  the  dil- 
ated proximal  end  of  the  appendix  had  been 
absorbed  (or  destroyed  by  ulceration  or  gan- 
grene), and  that  the  concretion  communicated 
with  the  lumen  of  the  bowel  on  each  side. 
The  appendix  and  the  concretion  were  removed 
and  the  two  portions  of  bowel  re-united  by  su- 
ture. The  concretion,  which  was  about  the  size 
of  ahorse-chestnut,  had  been  submitted  to  Dr. 
Ruttan  for  chemical  examination.  The  patient 
made  an  uninterrupted  recovery.  The  case.  Dr. 
Bell  thought,  was  of  interest  as  illustrating  one 
of  the  unusual  and  complicated  conditions  one 
may  meet  with  on  operating  for  appendicitis. 

(2)  Sarcoma  of  the  Upper  Jhird  of  the 
Tibia. — The  specimen  had  been  removed  that 
day  from  a  girl  23  years  old,  with  a  tubercular 
history.  The  tumor  was  first  noticed  two  and 
a  half  years  ago,  but  emaciation  had  only  be- 
come marked  during  the  past  eight  months. 
The  amputation  was  performed  in  the  middle 
third  of  the  thigh. 

Chloroform  Accident. — Dr.  Bell  next  gave 
the  history  of  a  chlorofrom  accident  which 
occurred  recently  in  his  hospital  practice^  and 
which  came  very  near  adding  one  more  victim 
to  the  fatalities  of  chloroform  anaesthesia.     On 


5: 


THE  CANADA  MEDICAL  RECORD. 


Thursday  of  last  week,  a  boy  eight  years  old, 
suffering  from  catits  of  the  lower  dorsal  verte- 
brae with  ]isoas  abscess,  was  prepared  for  oper- 
ation. He  had  been  in  the  hospital  one  month 
prior  to  this,  diirii  g  which  time  he  appeared 
in  good  health  ;  there  was  no  fever,  and  with 
the  exception  of  this  spinal  coi^dition  his  organs 
were  all  sound.  (Pr.  Bell  then  read  ihe  report 
of  the  anaesthetist.) 

Commenting  on  the  report,  the  speaker  re- 
marked that  it  was  imjiossible  to  say  whether 
the  pulse  or  res])iration  weie  the  first  to  cease, 
as  almost  at  the  some  moment  that  Dr.  Shaw 
discovered  the  stoppage  of  th  i  pulse.  Dr.  David- 
son observed  the  respirations  to  cease  with  a 
long  drawn  sigh.  Inversion,  artificial  respira- 
tion, cold  to  the  face,  with  hot  cloths  over  the 
cardiac  regie n  wereall'resorted  to,  and  it  seemed 
minutes  to  the  obseners  before  any  return 
of  respiration  or  cardiac  movements  mani- 
fested themselves.  He  thought  that  this  case 
demonstrated  the  hci  that  the  heart  does  stop 
suddenly  in  chloroform  poisoning, — in  some 
cases,  at  least, — and  that  death  is  not  always  due 
to  respiratory  failure  brought  on  by  ihe  admin- 
istration of  an  excess  of  the  drug.  Had  res- 
piratoryfailure been  the  initial  event  heie,  the 
heart,  as  in  all  cases  of  death  from  suspended 
respiration,  such  as  drowning,  hanging,  choking, 
etc.,  would  have  gone  on  beating  for  some  min- 
utes, instead  ofsiopping  instantaneously  as  here. 
The  converse,  however,  is  not  true  ;  that  is, 
respiration  does  not  continue  after  an  arrest  of 
the  heart's  action  ;  and  considering  these  facts, 
it  seems  clear  that  in  this  case  the  effect  of  the 
chloroform  was  exeixised  on  the  heart  primarily 
and  solely,  the  stop]  age  of  respiration  being 
secondary  to  it.  Moreover,  the  (luantity  of 
chloroform  administered  was  too  insignificant 
to  be  capable  of  affecting  the  respiratory  cen- 
tres, as  in  less  than  half  a  minute  before  the 
accident  the  boy  cried  out  "  take  it  off  my  face," 
and  only  a  few  drops  were  given  afterwards. 
An  interesting  feature  in  tlie  case  is  that  it 
contradicts  the  contention  of  the  Hydrabad 
commission,  that  the  heart  never  ^tops  first, 
but  that  death  from  chle^roform  is  always  the 
result  of  respiratory  failure  from  not  giving  the 
drug  properly. 

Dr.  Shepherd  thought  there  must  be  two 
classes  of  cases  in  chloroform  poisoning.  He 
had  a  case  last  winter  where  he  was  operating 
for  lupus  of  the  face,  in  which  chloroform  was 
used,  and  in  which  the  lespiiations  stopped 
while  the  heart  went  on  beating. 

Dr.  GoRboN  Camim'.eli,  believed  that  ihe 
preponderanc  e  of  clinical  evidence  is  in  favor 
of  tlie  heart  slo])ping  first.  He  ihen  wished  to 
know  if  the  boy  was  much  alaimed.  Dr.  Bell 
replied  in  tl  e  negative,  saying  that  he  was 
exceptionally  free  from  fear. 

Dr.  Wesi-ev  Mills  said  that  niost  of  the 
upholders  of  chloroform  as  an  anaisihetic  were 


simply  blinded  by  their  prejudices,  and  were 
incapable  of  seeing  or  believing  any  facts,  no 
matter  how  well  substantiated,  detrimental  to 
the  reputation  of  this  drug.  He  instanced  the 
fact  that  Surgeon  Major  Laurie  had  rpioted  the 
report  of  the  chloroform  commission  as  being 
entirely  in  favor  of  his  pet  belief,  while,  in  fact, 
it  contradicted  it.  And  such  is  the  attitude  of 
a  majority  of  the  defenders  of  chloroform  who 
belong  to  what  is  known  as  the  "  Syme  school," 
and  to  any  experience  establishing  untoward 
effects  their  reply  is  simply  "You  do  not  give 
it  pro])erly;  if  you  had  done  so,  the  accident 
would  not  have  happened." 

Dr.  Gordon  Campbell  agreed  with  Dr. 
Mills  in  his  strictures  on  the  men  of  the  '•  Syme 
school."  He  said  they  were  accustomed  to 
state  that  ether  was  only  used  by  second-rate 
surgeons,  and  that  it  only  affected  incomplete 
anaesthesia . 

T/ie  late  Dr.  Femvick. — The  following  reso- 
lution was  moved  by  Dr.  Shepherd  and  se- 
conded by  Dr.  Mills: 

Resolved — That  this  Society  has  learned 
with  the  most  profound  sorrow  and  regret  of 
the  death  of  Dr.  George  Edgeworth  Fenwick, 
one  of  its  foundation  members  and  a  past  presi- 
dent. I'or  many  years  a  most  active  and  valued 
member,  beside  taking  a  prominent  i)art  in  the 
discussions,  he  contributed  numerous  im]:)ortant 
])apeis  to  the  proceedings  and  exhibited  num- 
bers of  very  valuable  pathological  specimens. 

He  was  widely  and  favorably  known,  both 
in  Canada  and  abroad,  as  a  most  accompli^hed, 
original  and  daring  surgeon,  who  helped  to 
advance  surgical  science  in  various  directions, 
but  especially  in  the  sui-gery  of  the  joints. 

In  Canadian  medical  literature  he  always 
upheld  the  best  interests  of  the  profession  by 
protesting  against  abuses  and  advocating  re- 
form. 

His  kindly,  genial  manner  and  goodness  of 
heart  endeared  him  to  all  his  brethren,  and 
especiallj  made  him  the  friend  of  the  young 
])ractilionei-. 

Resolved — That  our  deej^est  sym])athy  be 
conveyed  to  his  son  owing  family  in  this  their 
time  of  mourning. 

Ahi  jial  Meeting. 

The  Iwenty-feiurth  annual  meeting  was  held 
on  Friday,  October  5th,  1894,  Dr.  James  Belt,, 
President,  in  the  chair. 

The  members  present  were:  Drs.  Wm. Gardner, 
G.  P.  Giidwood,  A.  Proudfoot,  James  Perrigo, 
J.  B.  McCorncll,  J-  Chalmers  Cameron,  F. 
Buller,  T.  Wesley  Mills,  D.  F.  Gurd,  J.  A. 
Macdonald,  G.  T.  Ross,  'lliomas  D.  Reed, 
James  Stewart,  J.  Alex.  Hutchison.  F.  R.  Eng- 
land, H.  S.  Birkett,  A.  W.  Gardner,  E.  H.  P. 
Blackaeler,  H.A.  Lafleur,  J.  H.  B.  Allan,  D. 
De  Cow,  J.  H.  Bell,  J.  A.  Springle,  G.  Gordon 


THE   CANADA    MEDICAL   RECORD. 


53 


Campbell,  James  M.  Jack,  J.  G.  McCarthy,  J. 
Leslie  Foley,  F.  A.  L,  [.ockhart,  J.  A.  \'lac- 
phail,  D.  J.  Evans,  VV.  S.  Morrow,  A.  E.  Orr, 
H.  1).  Hamilton,  H.  B.  Carmichael,  C.  F. 
Martin,  George  A.  Berwick,  S.  Ridley  Mack'  n- 
zie  and  Kenneth  Cameron. 

The  minutes  of  tlie  last  annual  meeting  were 
read  and  confirmed. 

Dr.  J.  M.  Jack,  tl^.e  Treasurer,  reported  that 
there  was  a  balance  of  $218.44  on  hand,  the 
receipts  having  been  $1,228.53  and  the  expen- 
diture $1,010.09. 

Dr.  Kenneth  Cameron,  Secretary,  reported 
thai  at  the  beginning  of  the  session  there  were 
117  ordinary  members,  15  new  members  were 
elected,  i  died  and  i  resigned,  making  a  present 
total  of  130;  of  these  114  are  resident  and  16 
non-resident. 

The  number  of  temporary  members  had  been 
greatly  increased  by  the  election  of  the  resi- 
dent staff  of  the  Royal  Victoria  Hosj)ital,  the 
total  membership  now  being  16.  No  honorary 
or  corresponding  member  was  elected. 

Twenty  regular  meetings  were  held  with  an 
average  attendance  of  33- 25  members  per 
meeting,  or  an  increase  of  2.25  members  per 
meeting  oer  last  year.  The  largest  attendance 
at  any  meeting  was  48  and  the  smallest  13 
members. 

Dr.  T.  D.Reed  the  Librarian,  read  the  fol- 
lowing report  : 

Considerable  difference  of  opinion  existed  as 
to  the  desirability  of  placing  the  libiary  and 
reading  room  in  a  different  story  of  thj  build- 
ing from  the  meeting  room;  the  separation 
has  now  been  accom[)lislied  for  a  year,  in  our 
present  quarters,  and  each  member  can  form 
his  own  opinion  of  the  change. 

The  number  of  readers  may  be  considered 
to  have  been  about  the  same  as  previous  years  ; 
exact  statement  on  this  point  cannot  be  made, 
as  members  have  access  at  will  to  the  room  bv 
private  key,  and  leave  no  record  of  attendance. 
The  Journals  have  been  maintainedas  before, 
and  tlie  valuable  series  of  London,  Philadelphia, 
New  York  and  Montreal  publications  have 
been  kept  up  by  binding. 

'Ihere  are  now  on  the  table  4  weekly  and  30 
monthly  journals. 

No  additions  to  the  library  by  purchase  have 
been  made,  as  the  Council  has  not  appro- 
priated any  money  for  the  purpose.  It  is  very 
desirable  that  the  Society  should  arrange  for  an 
annual  appropriation  for  the  purchase  of  the 
new  encyclopaedias,  dictionaries,  practices  and 
other  works  of  reference,  which  everyone  would 
like  occasionally  to  consult. 

We  are  indebted  to  Dr.  Blackader  for  a 
valuable  series  oi  Braithwa'te's  Retrospect. 

To  Dr.  Smith  and  others  our  thanks  are  due 
for  numerous  medical  journals. 

The  new  room,  though  small,  has  been  found 
comfortable  and  sufficiently  commodious  for 
the  present. 


The  following  officers  were  elected  for  the 
e.isuing  year : — 

President — Dr.  G.  P.  Girdvvood. 

ist  Vice-President — Dr.  J.  B.  McConnell, 

2nd  Vice-Pres'dent — Dr.  J.   x\le.x.  HurCHi- 

SON. 

Secretary — Dr.  G.  Gordon  Campcell. 

Treasurer — Dr.  J.  M.  Jack. 

Librarian  —  Dr.  F.  A.  L.  Lockhart. 

Council — Drs.  Jam  cs  BELr,  PEkRiCo  and 
Shepherd. 

Dr.  James  Bell,  ihe  retiring  President,  then 
lead  the 

annual  address. 

The  Constitution  and  By-Laws  of  the  Mon- 
treal Med  co-Chirurgical  Society  demand  of  the 
retiring  President  thai  "  He  shall  present  at 
the  annual  meeting  a  written  address,  which 
shall  include  a  resume  of  the  work  done  during 
the  year." 

You  have  already  heard  from  the  >  eport  of 
the  Secretary  that  we  have  now  a  larger  mem- 
bership, and  that  we  have  had  during  the  year 
just  ended  a  larger  attendance, both  average  and 
minimum,  than  ever  before.  From  the  Treas- 
urer we  have  learned  that  tiotwiihstanding  our 
more  comm  )dious  and  more  expensive  quar- 
ters and  the  great  expenses  incurred  in  fitting 
them  up  for  occupation,  we  have  a  surplus  of 
over  $200  at  the  end  of  the  year.  This  is 
undoubiedly  due  largely  to  the  adoption  by 
the  Society  of  better  business  methods  (as  well 
as  to  the  energy  of  the  Treisurer),  but  it  must 
also  be  taken  t )  indicate  a  greater  and  more  gen- 
uine interest  in  the  Society  by  the  profession  at 
large.  These  facts  speak  fur  themselves,  and 
constitute  an  effective  answer  to  those  who 
feared  thai  in  taking  these  rooms  which  we  at 
present  occupy  we  were  lau'iching  out  upon  a 
scheme  of  extravagance  which  would  ruin  the 
Society. 

Turning  now  to  the  professional  woik  of  the 
Society  during  the  year,  1  find  that  it  may  be 
summed  up  as  follows  :  There  were  9  papers 
and  9  case  reports  read,  19  living  cases  exhib- 
ited, and  upwards  of  73  specimens  presented. 
Besides  these,  3  demonstrations  were  given, 
which  are  noi  included  in  any  of  the  above  head- 

What  instantly  strikes  one  in  this  very  con- 
densed resume  of  the  professional  wo:k  is,  that 
while  on  the  vv'.iole  there  was  no  dearth  of  wjrk, 
there  were  only  9  papers  given  in  20  meeti  igs. 
Following  up  this  analysis,  we  find  that  among 
142  members  and  an  average  attendance  of 
33.25,  25  names  only  appear  as  contributors 
during  the  year.  Moreover,  the  discussions  have 
been  confined  to  a  small  proportion  of  the 
members  present  at  any  meeting.  This,  I  fear, 
is  the  weak  point  of  the  Society,  and  I  trust 
that  the  members  will  pardon  me  for  attention 
to  it.     With  every  department  of  medicine  re-^ 


54 


THE   CANADA   MEDICAL   RECORD. 


presented  on  our  programme,  as  they  have  been 
— clinically  and  pathologically — medicine  and 
surgery,  gynaecology  and  obstetrics,  ophthal- 
mology, otology  and  laryngology,  and  with  such 
a  wealth  and  variety  of  material  presented,  it 
seems  strange  that  lack  of  discussion  should  be 
a  feature  of  our  meetings.  I  am  sure  that  I 
voice  the  sentiments  of  the  older  members  and 
of  those  who  have  been  the  main  contributors 
in  the  past,  when  I  say  that  we  would  gladly  see 
the  younger  members  take  a  more  prominent 
part  in  the  preparation  and  the  discussion  of  pa- 
pers. Let  it  not  be  thought  for  a  moment  that 
here  some  are  teachers  and  some  are  siiidents, 
rather  let  it  be  understood  that  all  are  students 
and  all  may  be  teachers  ;  that  here  we  meet  on 
common  ground  for  mutual  benefit  and  for  the 
advancement  of  our  profession.  We  have 
abundant  facilities,  let  us  have  active  profes- 
sional work  in  the  Society  from  every  member, 
young  and  old.  This  is  all  that  is  needed  to 
make  our  Society  a  great  power  in  the  land 
In  fact,  it  is  already  a  great  power,  and  we  can 
look  with  pride  upon  the  part  which  it  has 
recently  played  in  several  great  public  reforms, 
notably  the  reform  of  the  national  quarantine 
system  within  the  last  two  years.  In  nuiking 
this  statement  I  do  not  wish  in  any  way  to  de- 
tract from  those  who  were  more  directly  res- 
ponsible for  the  reforms  mentioned,  but  Hmply 
to  state  the  fact  that  this  Society  did  not  stand 
aloof,  but  took  a  firm  and  uncompromising  posi- 
tion in  support  of  the  movement  for  reform. 

'Ihe  discussion  of  matters  concerning  th'^ 
health  of  the  public  and  the  welfare  of  ihe  pro- 
fession I  conceive  to  be  an  important  func- 
tion of  this  Society.  Further,  a  more  active 
interest  among  the  members  must  rapidly  de- 
velop a  higher  class  of  work— collective  inves- 
tigation, formal  discussions  on  important  sub- 
jects in  the  different  departments  of  medicine, 
committee  investigations  and  reports  on  mate- 
rial presented  at  the  meetings,  and  finally,  as 
an  outcome  of  all  this,  better  arrangements  for 
the  editing  and  i)ublishing  of  a  volume  of  the 
Society's  transactions  annually. 

There  is  another  matter  which  I  wish  to  spe- 
cially commend  to  the  thoughtful  consideration 
of  avery  member  of  this  Society.  A  year  ago  we 
celebrated  the  fiftieth  anniversary  of  the  found- 
ing of  the  Society ;  to-night  we  are  transact- 
ing the  business  of  the  twenty-fourth  annual 
meeting  of  its  second  renaissance.  Is  not  the 
time  ripe  for  the  establishment  of  a  pcrnanent 
home  for  the  Society?  We  are  domiciled  here 
in  our  present  quarters  for  four  years  more; 
and  although  at  this  moment  I  know  of  no 
scheme  on  foot,  or  even  suggested  for  the  pur- 
pose, it  does  not  seem  to  me  that  it  need  be 
looked  upon  as  entirely  Utopian  to  hope  that 
before  our  present  lease  has  expired  such  a 
scheme  should  at  least  be  well  under  way.  Of 
course   it  means    money,  and    I  know  too  wel) 


that  no  large  sum  of  money  could  be  raised 
among  the  members  of  this  Society;  hut  this  fact 
need  not  be  fatal  to  the  project.  We  see  hosj)!- 
tals,  schools,  libraries  and  institutions  of  all 
kinds  grow  up  around  us,  not  only  in  Montreal, 
but  elsewhere,  from  public  and  private  bene- 
factions, in  many  cases  directly  influenced  by 
medical  men.  Why  may  we  not  ho])e,  if  the 
want  is  made  known,  that  some  pub'ic-sj-irited 
citizen  will  in  the  near  future  bull  1  such  a 
monument  to  his  memory  ?  Such  an  institu- 
tion will  certainly  be  founded  in  .Montreal 
sooner  or  later.  Such  institutions  already  exist 
and  have  long  existed  in  all  great  medical  cen- 
tres, even  in  this,  the  new  world.  I  have  not 
inquired  into  the  histories  of  the  different  insti- 
tutions of  this  kind,  but  I  was  greatly  impressed 
by  the  fact,  noted  during  a  recent  visit  to 
Philadelphia,  that  the  Academy  of  Medicine 
of  that  city  is  now  nearly  two  hundred  years 
old.  What  we  want  is  a  permanent  abode,  not 
only  for  our  meetings,  but  where  we  may  estab- 
lish a  library  and  a  museum  for  reference,  and 
preserve  pictures  and  mementoes  of  the  great 
lights  of  the  profession  to  stimulate  us  and 
those  who  come  after  us  to  greater  efforts  and 
better  work.  In  conclusion,  gentlemen,  I  bt-g 
to  tender  you  all  my  sincerest  thanks  for  the 
honor  which  you  conferred  upon  me  a  year 
ago  by  electing  me  President  of  this  Society, 
and  for  the  confidence  and  support  which  you 
have  smce  accorded  me  as  its  presiding  officer. 


ELEVENTH    INTERNATIONAL   MEDL 
CAL  CONGRESS. 

Treatment  of  Blennorrhagic  Urethri- 
tis IN  THE  Female. — M.  Jullien,  of  Paris,  has 
employed  ichihyol  with  success  in  this  affection. 
He  applies  it  by  means  of  a  metallic  stem,  the 
extremity  of  which  is  wrapped  with  cotton  pre- 
viously soaked  in  ichthyol.  He  passes  and  re- 
passes the  instrument  into  the  urethra  with  a 
certain  degree  of  force.  He  also  uses  ichthyol 
to  kill  the  gonococcus  in  the  vaL;ina  or  uterus. 

Alumnol  in  the  treatment  of  Bi.f.nnorr- 
HAGiA. — Professor  Schwimmer.  of  Budapest, 
has  found  that  alumnol  is  an  astringent  and  anti- 
septic which  does  not  combine  with  albumen, 
as,  for  instance,  with  nitrate  of  silver,  thus 
enabling  its  effects  to  be  exerted  upon  the 
deepest  portions  of  the  connective  tissue.  He 
has  made  numerous  experiments,  in  cases  of 
acute  blcnnorrhagia  in  the  male,  with  aqueous 
solutions  of  from  ^  lo  5  per  cent.,  either  as 
injections,  urethral  irrigations,  or  instillations 
with  Guyon's  or  Ultzmann's  sound.  The  re- 
sults were  good.  In  acute  cases  alumnol  soon 
produced  a  certain  irritation  ;  in  chronic  case', 
it  was  better  supported,  but  the  duration  of  the 
treatment  was  no  shorter  than  with  other  reme- 
dies. In  blcnnorrhagia  in  the  female  the  results 
were  excellent  in  both  acute  and  chronic  cases, 


THli   CANADA   MEDICAL   RECORD. 


55 


patients  at  his  clinic  being  cured  in  from  two 
weeks  to  two  months.  The  remedy  was  appHed 
as  a  vaginal  injection  with  the  aid  of  speculum 
or  by  tampons  introduced  into  the  cervical 
canal. 

Radical  Cure  of  Epithelial  Cancer  of 
THE  Skin. — Dr.  Gavino  has  obtained  a  cure  in 
these  cases  by  the  following  mixture  :  Fuming 
nitric  acid,  lo  grammes  (2^  drachms)  ;  bi- 
chloride of  mercury,  4  grammes  (i  drachm); 
Berzelius  paper,  q.  s.  ad  consist,  sirup.  The 
remedy  is  applied  with  a  cotton  forceps,  repeat- 
ing the  cauterization  in  ten  or  twelve  days. 
This  will  be  sufficient  to  cause  the  largest  tumor 
to  fall  off,  when  cicatrization  soon  takes  place. 
Until  the  present  time,  the  speaker  had  had  100 
per  cent,  of  cures.  A  patient  of  Professor 
Pean's,  having  a  tumour  seventeen  centimetres 
in  diameter,  upon  which  the  surgeon  did  not 
wish  to  operate,  was  cured  in  about  eighteen 
days  by  this  means,  the  tumor  dropping  off 
entire,  nothing  remaining  but  the  cicatrizing 
wound. 

Indications  AND  Limits  of  Topical  Treat- 
ment in  Laryngeal  Phihisi^. — Dr.  Lennox 
Browne,  of  London,  read  a  paper  on  this  sub- 
jeer.  The  inflammations,  ulcerations,  and 
neoplasms  observed  in  the  larynx  during  the 
course  of  pulmonary  tuberculosis  are,  in  all  pro- 
bability, of  tuberculous  origin;  it  is  also  known 
that  there  exists  a  primar)  laryngeal  tuberculo- 
sis. Virchow  has  said  that  the  larynx  was  the 
most  favorable  spot  in  which  to  observe  the  al- 
terations of  the  disease;  it  is  also  the  most 
advantageous  region  for  topical  ajiplications. 
The  cures,  it  is  true,  obtained  by  this  method  are 
exceptional;  but  it  at  least  ariests  the  process 
and  is  much  better  than  ]alliative  measuies. 
Contrary  to  general  opinion,  the  improvement 
of  the  general  health  and  ot  the  lungs  is  not  the 
cause  but  very  often  the  direct  effect  and  the 
logical  result  of  local  efficacious  treatment  of 
lesions  of  the  upper  respiratory  passages.  The 
indications  for  topical  treatment  depend  upon 
(i)  the  state  of  the  larynx,  acute  or  chronic; 
(2)  the  degree  of  the  tuberculous  affection,  in- 
filtration, superficial  or  dee[)  ulceration,  necro- 
sis or  caries  of  the  cartilages,  and  development 
of  neoplasms;   (3)  the  state  of  the  lungs. 

The  results  of  treatment  in  102  cases  of 
laryngeal  phthisis  studied  by  eight  different 
observers,  grouped  in  the  author's  report,  show 
that  in  32  cases  in  which  both  lungs  were  dis- 
eased the  treatment  did  not  cure,  but  simply 
improved  the  condition  ;  in  31  cases  in  which 
the  disease  was  limited  to  one  lung  only,  but 
was  of  a  grave  nature,  cure  was  obtained  in  i 
case  and  improvement  in  8  cases.  In  24  cases 
in  which  the  lesions  were  limited  to  one  side, 
and  were  moderate  in  nature,  cure  was  obtained 
in  6  cases  and  improvement  in  16  cases;  and 
in  15  cases  in  which  there  were  no  pulmonary 
symptoms  2   cases  were  cured  and  7  were  im- 


proved. The  author  concludes  from  these 
statistics,  which  comprise  but  a  single  case  of 
cure  (that  being  one  of  his  own),  that  the 
chances  of  recovery,  and  even  of  improvement 
depend  to  a  large  degree  upon  the  the  co-exist- 
ence and  extent  of  pulmonary  disease. 

As  to  the  methods  and  limitations  of  treat- 
ment he  does  not  advise  the  use  of  morphine, 
except  in  hopeless  cases ;  nor  cocaine  except 
for  intralaryngeal  curettage,  for  applications  of 
lactic  acid,  or  for  the  temporary  relief  of  dys- 
phagia. All  medicaments  (except  lactic  acid) 
should  be  applied  as  a  spray,  and  not  in  the 
form  of  insufflated  powders.  Menthol  or  men- 
thol combined  with  iodol  and  dissolved  in  oil 
is  one  of  the  best  remedies  in  the  stage  preced- 
ing ulceration.  The  curette  may  be  employed 
to,  destroy  the  hyperplasia,  to  remove  dead 
matter  from  the  large  ulcerations,  and  to  unite 
the  small  multiple  ulcers  into  a  single  large 
one.  The  curette  may  also  be  of  value  prior 
to  the  application  of  lactic  acid^  but  its  use  in 
this  connection  is  not  indicated  in  more  than 
a.  fifth  of  the  cases.  Lactic  acid,  to  be  really 
efficacio  IS,  should  be  employed  with  friction. 
Puncti.rj  and  incision  of  the  infiltrated  tissues, 
as  practiced  by  Schmidt  and  Rosenthal,  should 
be  avoided,  as  they  produce  no  favorable 
result  and  hasten  the  development  of  ulcers. 
Extirpation  of  the  arytenoid  cartilages  (Heryng 
and  Gouguenheim)  is  not  to  be  advised,  as 
these  are  rarely  the  seat  of  morbid  alteration  ; 
and  if  such  alterations  do  exist,  the  disease  is 
at  such  an  advanced  state  that  intervention  is 
contraindicated. 

According  to  the  author's  observations, 
tracheotomy  should  not  be  performed  in  tuber- 
culosis of  the  larynx.  While  applying  the 
topical  treatment  the  rules  of  hygiene  and  in- 
ternal medication  should  be  considered,  as  well 
as  the  climate  best  adapted  to  each  patient. — 
Le  Semaine  Medic  ale,  April  4,  1894. 


VIENNA  MEDICAL  SOCIETY. 

Vasomotor  Phenomena  in  Fever. — Prof. 
F.  Kraus  reviewed  the  various  prevalent  theo- 
ries upon  the  vasomotor  phenomena  of  fever, 
particularly  those  of  Heidenhain,  Senator, 
Bouchard,  and  Charrin.  It  is  known  that  dur- 
ing the  stage  of  chill  the  turgescence  of  the  skin 
is  diminished,  the  superficial  arteries  are  con- 
tracted, and  the  peripheral  temperature  is  low- 
ered, while  the  central  temperature  is  increased. 
The  diminution  in  the  turgescence  of  the  skin 
is  due  to  contraction  of  the  small  arteries,  and 
at  the  height  of  the  fever  increases  after  dilata- 
tion of  the  cutaneous  vessels ;  the  venous  blood 
is  also  redder  than  in  the  normal  state.  Ther- 
mo-electric examinations  made,  by  the  speaker 
in  fever  patients  showed  that  the  vasomotor 
reflexes  of  the  skin  were  preserved,  and  that 
the  vessels  alternately  contracted   and  dilated, 


THE   CANADA   MEDICAL   RECORD. 


From  calorimeiric- examinaiion  he  convinced 
liiniseif  that  the  elevation  of  temperature  was 
coincident  witli  a  diminiiti  )n  in  heat  radiation. 
Antipyretics  increased  this  radiation  to  a  gre  it- 
er degree  than  did  cold  water.  He  also  found 
that  the  number  of  red  cells  and  ihe  blood-plas- 
ma were  not  modified  during  fc\er.  His  re 
searches  show  the  importance  of  vasomotor 
phenomena  in  fever,  but  do  not  explain  the 
process.  It  seems,  however,  that  toxic  agents 
act  ujjon  the  vasomotor  nervous  system,  u[)on 
which  depend  the  thermogenic  process  and  lieat 
radiation, — a  view  already  advanced  by  Bill- 
roth.— Internationale  kliti.  Rundschau,  March 
25.  1894- 

Trkatment  OF  Larvn(;eal  Phthisis-  —  Dr. 
Hajek  ])resented  a  patient  with  laryngeal  tub- 
erculosis upon  whom  he  had  tried  a  new  tieat- 
ment.  The  infiltration  of  the  epiglottis  was 
so  great  that  the  man  could  no  longer  swallow. 
Dr.  H;ijek  removed  tlie  entire  ei-'igloilis  by 
means  of  a  galvano-caustic  loop,  and  treated 
the  wound  v.-ith  lactic  acid  Four  weeks  later 
tin-  patient  was  able  to  swallow  with  ease. 
Since  then  he  had  curetted  one  of  the  voc  il 
cords,  which  was  ulcerated.  This  was  also 
dressed  with  lactic  acid  and  healed  re  .dily.  It 
is  now  one  year  since  the  epiglottis  was  extir- 
]jaled,  and  the  (  ure  is  maintained.  The  patient 
has  increased  in  weight  19  kilogrammes  (38 
pc'Unds),  i)roving  that  his  general  condi;i.)u  is 
better.  Dr.  Hajrk  stated  ihat  ht;  had  abeady 
extirpated  ihe  e]jiglotiis  of  three  p.itients.  The 
operation  is  ea^y,  ;.nd  there  is  no  great  dan- 
ger of  hceniorrhnge.  It  is  indicated  in  cases  of 
infiltnition  ur  ci.cumscribed  tumors.  The 
case  proves,  besides,  in  his  opinion,  that  the 
prognosis  of  laryngeal  phthisis  is  not  so  giave 
as  one  would  sup;/OSe, — La  Scmaine  Midicale, 
Manh  14,  1894- 


BEKLIN  MEDICAL  SOLTF'IY. 

RtSECTION     OF     THE     INTESTINE. .icrr    J. 

Israel  showed  a  woman,  aged  85  yejrs,  upon 
wluim  he  had  operated  for  carcmoma  of  the 
transverse  colon  twenty  months  previously. 
For  twenty  years  she  had  suffered  from  intis- 
linal  obstruction,  which  for  two  years  pie- 
vibus  to  operation  had  become  habitual,  l^ft 
iliac  colotomy  was  perfoimed,  ai.d  one  year 
laier  she  reltirned  to  hospitil,  with  pro'ape 
of  the  upper  portion  of  the  intestine.  In  this 
prolapsed  portion  hard  car  inomatc  us  masses 
could  be  felt.  These  were  resec.ed  and  were 
found  to  have  their  seat  on  the  surface  of  the 
transverse  colon.  Several  m.)nil.s  later,  afltr 
assuring  himself  that  the  .mestine  was  perme- 
able ll.roughout,  Herr  Israil  sutured  the  t'O 
ends  and  closed  the  artifi(  iai  anus. 

Heir  HmIui  remarked,  in  ilie  discus-ion,  that 
eldeib  w.  men  eemetl  to  be.ir  such  o,.iialions 
lemarkably  well.     He    had   operated    uixjii  a 


woman  of  70  years,  who  suffered  from  intestinal 
occlusion,  and  who  recovered  without  incident. 

Herr  Rotter  stated  that  it  is  not  his  practice 
to  establish  an  artificial  anus  in  the  iliac  region 
except  when  the  carcinoma  is  situated  in  the 
rectum.  If  it  is  impossible  to  discover  the 
exact  location  he  practices  laparotomy,  having 
in  this  way  cured  three  patients  whose  con- 
dition was  desperate  In  one  f  f  these  the 
tumor  was  at  the  left  bend  of  the  colon  and 
was  inoperable.  He  made  an  astomosis  be- 
tween the  ascending  and  transverse  colon.  The 
patient  supported  the  operation  well,  dying 
several  months  later  from  carcinomatous  ca- 
chexia. 

Herr  Israel  agreed  with  Herr  Roiter,  but 
believed  that  the  patients  would  oppose  his 
metliods.  as  an  artificial  anus  was  a  source  of 
great  relief  to  them. —  Universal  Medical  Jour- 
nal. 


Ironrcss    ot     Sciciuc 


OUTERBRIDGE'S  OPERATION  FOR 

HEMORRHOIDS. 

By  a.  Ernest  Gallani,  .M.I)., 

NEW    YORK. 

[Written    for  Mattheius'  Medical  Quarterly.'] 

In  a  recent  number  of  the  Provincial  Medi- 
cil  Journal  (Matthews'  Medical  Quarterly, 
Vol.  I,  page  326),  Robert  Jones,  of  Liverpool, 
published  "a  simple  method  of  treating  the 
wound  after  excising  hemorrhoids,"  and  dien 
says  he  "  does  not  intend  to  use  ihe  cautery 
again." 

Believing  that  simplicity  in  operative  tech- 
nique is  the  sine  qua  non  to  success,  Dr.  Outer- 
bridge,  since  1888,  has  given  up  the  use  of  the 
ligature,  clamp  and  cautery,  etc.  and  pursued  the 
f  )llowingplan  for  the  cui  e  of  hemorrhoids.  His 
experience  with  this  operation  numbers  from 
one  hundred  and  twenty-fi\e  to  one  hundred 
and  fifty  cases  of  all  degrees,  varying  from  the 
simple  external  "  tab  "  to  the  most  severe  case 
of  internal  hemorrhoids,  with  i)rolapsus  of  the 
whole  "  hemorrhoidal  inch."  As  a  part  of  the 
general  physical  examination  in  every  case 
which  comes  under  his  care,  Dr.  Outerbndge 
makes  it  a  rule  to  explore  the  anal  legion.  Later, 
when  the  patient  is  anesthetized,  after  having 
completed  any  other  surgical  procedure  which 
the  condition  of  the  patient  may  call  for,  he 
rectifies  the  condition  at  the  anus  at  one  and 

I    the  same  seance. 

'i"he  preparation  of  the  patient  (and  this  rule 
holds  good  in  all  cases   for  operation)  consists 

i    of'(i)  the  administration  of  a  laxative  on  the 
second  night   preceding  the  day  of  operation, 


THE  CANADA  MEDICAL  RECORD. 


57 


Ksually  resulting  in  a  ihoruugh  evacuation  of 
the  bowelr;  on  the  t\)llo\ving  day  and  an  interval 
of  rest  of  Irom  twelve  to  twenty-four  hours. 
Wlien  the  atjove  ]:)lan  is  carried  out,  the  rectuin 
will  be  found  empty  at  ihe  time  for  operation, 
and  patients  do  not  complain  of  pain  from  ex- 
cessive  perisialsis  and  rectal  tenesmus  ;  (2)  in 
persons  with  excessive  giowlh  of  hair,  it  will  be 
necessary  to  cut  away  the  excess,  but  it  will  add 
much  to  the  comfort  of  the  j^alient  if  this  cm  be 
avoided,  as  the  short  hairs  project  into  the 
opi)osite  buttock  and  cause  needle-like  pain 
and  much  irritation  for  two  or  three  weeks  after 
operation. ' 

In  view  of  the  fact,  so  often  overlooked  by 
anesthetists,  that  the  sphincteric  reflexes  are 
almost  the  last  to  be  abolished,  the  degree  of 
anesthesia  must  be  more  profound  than  for  any 
other  sureical  procedure.  With  the  subject 
thus  anesthetized,  the  sphincter  ani  must  be  fully 
dilated  with  the  thumlis,  when  the  hemorrhoi- 
dal mass  will  be  brought  into  full  view. 

Thor  jugh  scrubbing  of  the  anal  region  and 
washing  the  mucous  membrane  well  above  the 
operative  field  with  tinctura  saponis  viridis  and 
warm  water  apy)  ars  to  be  the  most  efficient 
meaiis  for  cleansing  ])uri)Oses.  It  is  a  practical 
imposMbility  to  render  mucous  membrane  asep- 
tic, so  that  gross  cleanliness  is  all  that  can  be 
obtained. 

For  practical  jmrposes  in  doing  this  operation 
we  may  divide  the  cases  into  two  vaiiclies  : 

1.  Cases  with  only  external  "  tabs  "  or  with 
the  more  frequent  arrangement  of  three  tumor- 
like masses  just  inside  the  sphincter  ani,  usually 
CO-  sidered  most  suitable  for  clamp  and  cautery 
or  ligature.  These  may  bo  dealt  with  in  the 
following  way  :  Grasp  with  a  pair  of  thumb 
forceps,  or  insert  the  point  of  a  tenaculum  into 
the  most  prominent  portion  of  the  "  tab  "  or 
tumor.  Make  enough  traction  at  right  angles 
to  tlie  gut  to  clearly  define  the  mass.  Surround 
it  with  ihe  blades  of  a  pair  of  scissors  (curved 
on  the  flat)  pn.ssed  well  toward  the  muscle, 
and  with  one  or  two  cuts  the  diseased  tissue  is 
removed.  'I'his  will  leave  an  elliptical  raw  sur- 
face, the  edges  of  which  can  now  be  united  by 
a  continuous  ca'gut  suture.  Each  distinct 
mass  is  amputated  and  sutured  in  the  same 
way. 

2.  Those  cases  where  the  whole  "  hemorr- 
hoidal inch"  is  dilated  and  ordinarily  considered 
as  most  successfully  treated  by  Whitehead's 
method.  These  may  be  handled  as  follows  : 
Having  thorougldy  dilated  the  sphincter,  the 
hemorrhoidal  ling  will  protrude  from  the  anus. 
^Vith  a  pair  of  th.unib  fo.ceps  grasp  a  pait  of 
the  mass,  and  with  the  curved  scissors  cut  away. 
a  strip  of  mucous  membrane  and  hemorrhoidal 
tissue,  down  to  the  muscle,  following  the  line  of 
tlie  muco  Ciitaneous  junction  all  round  the 
lumen  of  the  gut.  A  sec  md  or  third  strip  may 
be    removed    whenever    liie  size    of  the    mass 


necessitates.  If  external  hemorrhoi  Is  ("  tabs") 
are  also  present,  in  order  to  prevent  recurrence 
in  th.it  region,  pruritus  and  the  numerous  dis- 
comforts usually  following  the  operation  as 
ordinarily  done,  a  strip  of  skin  down  to  the 
sphincter  ani  is  remcived  in  the  same  way.  The 
free  edges  of  the  skin  and  mucous  membrane 
are  now  brought  together  with  a  continuous 
catgut  suture.  A  double  stitch  may  be  taken  at 
two  or  tiiree  points  in  the  circumference  of  the 
bowel  to  interrupt  the  sutures,  and  thus  avoid 
the  necessity  of  tying.  Owing  to  the  rapidity 
with  which  the  diseased  tissue  can  be;  removcvi 
and  the  suturing  accomplished,  the  slight  hem- 
orrhage which  occurs  is  ■■■i  once  controlled  with- 
out the  use  of  artery  clamps  or  the  necessity  of 
ligating  bleeding  points.  Should  bleeding  occur 
at  any  point  immediately  after  sutu'ing,  an  extra 
suture  at  that  i)oint  will  at  once  control  it.  If 
during  the  removal  of  the  mass  any  vessel  bleeds 
excessively,  it  can  be  quickly  controlled  by  at 
once  beginning  to  suture. 

The  excision  of  hemorrhoids  after  the  mai  - 
ner described  ]:)resents  the  following  advantages  : 

1.  Its  extreme  simplicity. 

2.  'I'he  instruments  required  are  found  in  an 
ordinary  pocketcase. 

3.  Primary  union,  and  as  a  result  little  or 
no  pain  ;  no  rectal  or  vesical  tenesmus  ;  no 
retention  of  urine;  no  infection  ;  no  tempera- 
ture; no  sloughing,  gianulating  ma^>s  ;  and  a 
minimum  amount  of  cicatricial  tissue.  All 
danger  of  second  iiy  hemorrhage  is  av  )ided  ;  the 
bowels  are  not  confined  before  or  after,  doing 
away  with  all  the  unpleasant  effects  of  opium 
and  the  discomforts  of  enemata ;  the  use  of 
tubes,  packing,  etc.,  is  unnecessary  ;  there  are 
no  sutures  to  be  removed. 

4.  Time  ;  the  operation  requires  but  a  few 
minutes. 

5.  Short  time  in  bed.  In  cases  where  no 
other  operation  has  been  don?,  the  patient  is 
allowed  to  get  up  on  the  third  day  and  attend 
to  his  ordinary  duties. 

6.  Recurrence  has  not  taken  pi  ice. 
35  We^t  Fifty-Third  Street. 


SALOL    IN    DIARRHCEA. 

C.  G.  L.  Skinner  {^Medical  Chronicle ;  At- 
lanta Medical  and  Surgical  Journal^.  Silol  is 
a  compound  of  j)henol  and  salicylic  arid,  con 
Gaining  about  foity  per  cent,  of  the  former  and 
sixty  per  cent,  of  the  latter.  It  is  insoluble  in 
water.  In  acid  media  it  undergoes  no  change, 
but  in  alkaline  fluiJs,  and  also  by  the  action  of 
micro-organism-;,  it  readily  splits  up  at  the  tem- 
perature of  the  body  into  [jlienol  or  car!)olic 
acid  and  salicylic  acid. 

If,  then,  we  give  salol  to  a  patient,  it  passes 
umhanged  llirough  the  acid  contents  of  the 
stomach,  but  on  coming  in  contact  with  the 
alkaline  pancreatic  juice,  splits  u[)  into  carbolic 


58 


THE   CANADA   MEDICAL   RECORD. 


acid  and  salicylic  acid,  which  thus  exert  their 
full  effects  on  the  contents  of  the  intestines,  and 
we  have  the  bowel  washed  out  with  an  antisep- 
tic solution.  If  we  take  into  consideration  that 
in  diarrhoea  absorption  in  the  bowel  is  nodoult 
less  active  than  in  health,  and  also  that  the 
micro-organisms  which  abound  in  the  intestines 
aid  us  in  compassing  their  own  destruction  by 
splitting  up  any  of  the  salol  which  may  have 
escaped  the  action  of  the  pancieatic  juice,  I 
think  we  must  admit  that,  theoretically  at  least,- 
salol  is  more  apt  to  give  good  antiseptic  results 
than  the  other  drugs  more  commonly  prescribed, 
A  further  advantage  is  that  a  larger  dose  of 
carbolic  acid  can  be  given  in  the  form  of  salol, 
owing  to  its  non-absorption  in  the  stomach,  than 
if  the  drug  itself  is  prescribed. 

May  not  the  local  action  of  many  other  drugs 
on  the  interior  of  the  alimentary  canal  be  too 
much  overl  Joked  ?  Some  years  ago,  in  a  paper 
on  anemia,  the  late  Sir  Andrew  Clarke,  after 
suggesting  as  the  cause  of  the  disease  absorp- 
tioii'of  foul  gases  in  the  intestines,  gives  it  as  his 
opinion  that  tiie  value  of  iron  consists,  not  so 
much  in  restoring  the  red  corpusc'.es,  as  in 
forming  an  astringent  lotion  to  apply  to  the  in- 
terior of  the  bowel,  thus  preventing  the  forma- 
tion of  these  gases.  Do  modern  therapeutists 
devote  too  much  research  to  dilatation  and  con- 
traction of  capillaries  and  effects  on  nerve  end- 
ino-s,  and  too  little  to  the  immediate  action  of 
drugs  on  the  gastro-intestinal  mucous  mem- 
brane ? 

•During  an  epidemic  of  summer  diarrhcea,  of 
twenty-three  cases  ireatcd  with  salol,  only  one, 
a  child  eight  months  old,  proved  fatal.  In  very 
few  cases  were  more  than  tliree  or  four  doses 
necessary,  and  rarely  were  more  than  one  or 
two  loose  stools  passed  after  taking  the  first._ 
Ordinary  catarrhal  diarrhcta,  due  to  errors  of 
diet,  diarrhoea  of  children,  diarrhoea  occurring  in 
the  course  of  some  other  disease,  tsvo  or  three 
doses  seldom  fail  to  arrest,  while  in  the  diarrho3a 
of  tuberculosis  it  can  generally  be  relied  upon  to 
give  temporary  relief.  It  has  been  recommended 
in  typhoid  fever,  but  I  have  no  experience  of 
its  use  in  that  disease,  nor  am  I  aware  that  it 
has  been  given  in  cholera;  but  it  seems  to  be 
well  worth  a  trial,  and  at  least  os  likely  to  prove 
effectual  as  any  drug  yet  employed. 

In  all  these  varieties  ot  diarrhoea  the  good 
effects  of  salol  are  most  probably  due  entirely 
to  its  direct  antiseptic  action  on  the  bowel  con- 
tents—destroying bacilli,  controlling  acid  fer- 
mentation of  food  and  the  putrefaclive  pro- 
cesses. The  sedative  action  of  carbolic  acid 
will  also  lessen  the  peristaltic  movements, 
and  so  relieve  pain.  The  dose  of  salol  for 
an  adult  is  ten  to  fifteen  grains  (best  adminis- 
tered in  a  spoonful  of  gruel  or  barley  water), 
which  may  be  repeated  every  four  or  six  hours  : 
to  a  child  a  year  old,  one  or  two  grains  may  be 
given.     It   is     very     rarely    rejected    by    the 


stomach,  and  in  the  above  doses  does  not  pro- 
duce unpleasant  after-effects. 

RUPTURED   GASTRIC     ULCER   SUC- 
CESSFULLY TREATED  BY  ABDOM- 
INAL SECTION  AND  SUTURE. 

T.  H.  Morse  {British  Medical  Joirnal, 
1733).  The  patient,  a  young  lady  aged  twenty, 
having  had  symptoms  of  gastric  ulcer,  was  sud- 
denly seized  with  pain,  followed  by  faintnessand 
vomiting.  The  pain,  which  was  of  a  burning 
character,  commenced  over  the  region  of  the 
stomach,  and  gradually  extended  all  ovei 
the  abdomen.  Abdominal  section  was  per- 
formed nearly  five  hours  after  the  commence- 
ment of  symptoms  ;  the  consents  of  the  stomach 
were  found  in  the  peritoneal  cavity.  The  stom- 
ach was  withdrawn,  and  a  perforation  found  on 
the  anterior  surface  close  to  the  cardiac  oiifice. 
The  organ  was' washed  out  and  the  perforation 
closed  with  Lembert's  sutures  ;  the  stomach  was 
returned,  the  peritoneal  cavity  washed  out,  and 
the  wound  united.  No  food  wa^  given  by  the 
mouth  for  sixty  hours,  and  at  the  i.n  1  of  three 
weeks  the  patient  was  quite  well.  The  author  had 
not  up  to  the  present  time  seen  a  record  of  any 
other  successful  case  of  this  kind  in  this  country, 
though  cases  had  been  reported  by  Drs.  Pen- 
rose and  Dickinson,  also  by  Mr.  Gilord  and 
Mr.  Barling,  and  by  Mr.  Warrington  Haward, 
references  to  which  were  to  be  found  in  the 
British  Medical  Journal  of  the  past  year. 

Mr.  Barwell,  in  the   discussion,  said  that  he 
had    been   able   to  find    tw.-nty-five   cases   on 
record  of  closing  a  rupture  in  the  stomach  wall, 
and  there  were  at  least  four  Others.     In  one  of 
the  twenty-five  cases   there  was  a  localized  ab- 
scess close  to  the  small  curvature  ;  this  abscess 
was  opened,  and  that  was  all  that  was  found  to 
be  necessary.   He  then  described  Kriege's  case. 
Mr.  Barwell  suggested   the    following   points, 
which  he  thought  might  point  the  way  to    suc- 
cess :    First,    to  operate  as    soon   as  possible  ; 
secondly,  that  the  incision  through  the  abdom- 
inal wall  should    be  to   the  left  of  the   middle 
line  ;  thirdly,    to   search   very   thoroughly   the 
front  wall  of  the  stomach,  as  in  these  cases  the 
opening   was   for  various  reasons  liable  to    be 
hidden  by  1\  mph,  puckering,  etc.    He  suggested 
that  it  might  be  advisable  to  introduce  jnto  the 
patient's  stomach  some  colored  fluid,  such  as 
coffee,  for  this    purpose.     He  could  not  agree 
with  Mr.  Haward  that  it   was  necessary  to  cut 
away  the  margin  of  the  ulcer  before  suturing 
the  stomach.     He  thought  that  Mr.  Morse  had 
done  very  wisely  in  washing  out    the  stomach, 
and  also    in  eschewing  antiseptics   in  washing 
out    the    peritoneum.     Mr.  Barwell    had    seen 
very  good  results  in  washing  out  the  peritoneum 
with  warm  distilled  water  in  restoring  patients 
from'CoUapse  during  abdominal  operations. 


THE   CANADA   MEDICAL   RECORD. 


59 


THE  ANTITOXIN  TREATMENT  OF 
DIPHTHERIA. 

The  favorable  reports  which  are  being  re" 
ceived  from  various  quarters,  of  the  successfu 
irealmeiit  of  diphtheria  by  Aronson's  antitoxin) 
an  antidote  prepared  from  the  cultivation  of 
the  diphtlieria  bacillus,  with  attenuation  of  its 
toxicity,  seem  to  indicate  that  it  will  be  classed 
with  the  groat  discoveries  of  Pasteur  and  Jenner. 
It  is  claimed  to  possess  an  advantage  over 
these,  however,  in  the  fact  that  it  not  only  pro- 
duces an  imm.iniiy  from  the  disease,  but  also  has 
a  curaiive  effect  after  th^e  disease  has  already 
been  contracted.  The  earlier  in  the  course  of  the 
disease  the  treatment  is  instituted  the  better, 
and  when  the  injections  are  made  in  the  first 
lew  days,  the  reports  show  that  the  disease  does 
not  extend  to  the  larynx,  and  the  complications 
and  sequelae  have  been  of  a  normal  character. 
The  dose  varies  from  5  to  25  CD.  (i}{-C>}(  fi 
drs.)  according  to  the  age  of  the  child  and  sever- 
ity of  the  case,  and  may  be  repeated  on  the 
following  day  if  necessary.  The  usual  place  of 
injection  is  in  the  back,  below  the  scapula. 
The  injections  seem  to  be  followed  by  no  disa- 
greeab'e  symptoms,  and  in  from  twelve  to 
twenty-four  houis  there  is  a  fall  in  the  tempera- 
ture (often  to  normal)  accompanied  by  marked 
improvement  in  the  general  condition. 

The  most  extensive  tests  of  this  new  treat- 
ment have  been  made  in  the  Kaiser  Freidrich 
Children's  Hospital,  v.'here  1,081  cases  of  diph- 
theria had  been  treated  by  the  usual  methods, 
with  a  mortality  of  38.9  per  cent.  Some  months 
ago  the  antitoxin  treatment  was  begun  there, 
and  since  that  time  128  cases  have  been  treated 
by  this  method  with  a  mortality  of  13.2  per 
cent.  Dr.  Katz  also  reports  having  inoculated 
72  children  exposed  to  thedisease,  and  of  these 
only  8  were,  attacked,  and  so  slightly  as  to  be 
free  from  evil  consequences. 

One  great  disadvantage  in  the  employment 
of  antuox^n  is  that  it  is  very  expensive,  and  this 
pliAces  \i  beyond  the  reach  of  poor  people,  un- 
less \.\ie  municipal  and  Stale  sanitary  authorities 
come  ^o  vbeu  aid.  In  New  York  City,  this  will 
probably  be  done  at  an  early  date,  as  Dr.  Her- 
man Biiggs,  bacteriologist  of  the  Board  of 
HeaUb  of  the  city,  has  recently  returned  from 
Berbv\,  where  he  has  been  studying  the  manu- 
facture and  results  obtained  by  the  use  of  the 
remedy,  and  has  reported  so  strongly  in  favor  of 
it,  that  ihe  Board  of  Health  has  asked  for  an 
appropriation  in  order  to  enable  them  to  under- 
take its  manufacture. — Medical  Fortnightly. 

THE  CAUSE  AND   r::RCENTAGZ    OF 

MYOPIA. 

At  this  season  of  the  year,  when  our  school 
children  are  flocking  home  with  bright  eyes  and 
healthy  cheeks,  from  country,  mountain,  lake 
and  sea;  when  the  house  is   being   ransacked 


from  top  to  bottom  in  search  of  the  school  books 
which  were  so  gladly  thrown  down  in  the  early 
summer ;  when  teachers  and  scholars  alike  are 
preparing  for  another  year  of  arduous  work,  it 
seems  a  fitting  time  to  offer  some  suggestions  as 
to  the  cause  and  prevention  of  myopia.  The 
ground  upon  which  we  base  our  remarks  is  as 
follows  :  We  know  that  myopia  is  an  acquired 
disease  or  condition,  occurring  ordinarily  during 
school  life ;  that  as  the  children  advance  in 
grade,  the  number  of  myopes  increase.  Accord- 
ing to  Fuchs,  about  20  percent,  of  the  German 
students  are  myopic  in  the  lowest  classes  of  the 
high  schools,  and  about  60  per  cent,  in  the  high- 
est classes. 

Countless  monographs  have  been  written 
attempting  to  prove  that  the  arrangements  in 
schools,  the  light  and  air  space,  height  of 
benches  and  desks,  print  of  books,  etc.,  are 
important  factors  in  the  production  of  myopia. 
While  admitting  that  badly  lighted  schools, 
etc.,  aggravate  the  tendency  toward  myopia,  we 
must  evidently  look  elsewhere  for  the  cause,  since 
we  find  that  the  greatest  increase  in  myopia  occurs 
in  our  high  schools,  colleges  and  universities, 
buildings  which  are  as  perfect  as  money  or 
science  can  make  them.  Where,  then,  shall  \ve 
look  for  the  cause  ?  Let  us  study,  for  a  moment, 
the  school  life  of  a  child  from  the  day  it  is  thought 
old  enough  to  go  to  school  until  the  day  of 
graduation.  The  first  years  of  school  life  are 
regarded  by  the  child  as  so  many  hours  of  hard- 
ship, hours  cut  off  from  play.  The  little  dears 
may  seem  much  occupied  with  their  lessons, 
but  the  girl  is  thinking  of  her  doll,  and  the  boy, 
of  his  top  and  marbles. 

When  the  bell  rings  for  recess  or  at  the  close 
of  the  session,  the  books  are  shut  as  quickly  as 
the  laborer  drops  his  shovel  at  knocking  off 
time.  So  it  is  safe  to  say  that  the  children  are 
not  ruining  their  eyes  at  this  period  of  the 
school  work.  But  the  years  pass,  and  as  the 
scholars  advance  in  grade  the  studies  become 
more  difficult,  the  thirst  for  knowledge  in- 
creases, the  children  become  ambitious  and  find 
N  the  school  hours  all  too  short  to  master  their  les- 
(  sons.  Then  they  carry  a  bo'^k  home  so  that 
they  can  do  a  little  work  after  supper. 

The  father  and  mother  praise  them  for  their 
diligence,  instead  of  sending  them  to  bed.  It 
is  at  this  time  we  i^otice  the  development  of 
myopia.  We  now  reach  the  high  school,  and 
find  every  one  under  high  pressure.  The  amount 
of  work  required  necessitates  closer  and  closer 
application  during  school  hours,  and  an  ever 
increasing  amount  of  work  to  be  done  at  home. 
'f'his  p-r  i- t:ni  u-e  of  the  eves,  often  by  dim 
light,  without  propec  intervals  of  rest,  overtaxes 
the  eyts  and  furnishes  fitting  soil  for  the  rapid 
increase  of  myopia. 

'I'he  means  by  which  we  mayliope  to  prevent 
the  development  and  retard  the  progress  of 
myopia  are  clear,  and  can  be  summed  up  in  a 


6o 


THE  CANADA  MEDICAL  RECORD. 


few  words.  We  must  insist  upon  proper  inter- 
vals of  rest  for  the  eye«,  and  allow  the  children 
a  liberal  amount  of  play  time.  To  this  c  nd  les- 
sons should  be  studied,  as  much  as  possible, 
during  school  hours,  and  night  woik  at  home 
should  be  discouraged.  Possibly  we  can  all 
recall  the  tired  parent  saying,  as  he  settles  down 
to  his  j)aper  afier  su])i)er  :  "Now, boys,  get  your 
books,  an  J  don't  let  me  hear  a  word  out  of  you, 
or  off  you  go  to  bed." 

Lei  the  boys  have  a  good  romp,  and  if  you 
possib'y  can,  romp  with  theio,  and  then  after 
they  have  been  tucked  away  in  bed,  you  can 
enjoy,  all  the  more,  a  quiet  chat  with  your  wife 
or  pel  use  your  paper  in  quiet  and  peace.  And 
when  they  g  ow  older  and  enter  die  high  school 
or  college,  see  to  it  thai  they  do  not  burn  the 
midnight  oil,  do  not  overtax  tiie  eyes,  for  as  long 
as  they  do  it,  they  do  dan)age  to  the  eyes,  whe- 
ther they  study  in  a  badly  arranged  school  or 
in  one  of  our  great  universities. — Medical 
Fortnightly. 

A  NOVEL  WAY  OF  GIVING  AN  ENEMA- 

Dr.  George  Koss  reported  the  case  o»'  a  man 
recently  under  his  obseivation,  who  had  just 
died  from  peiiloniiio,  cause  1  by  the  bursting  of 
the  bowel.  It  seems  that  he  had  been  in  the 
habit  of  attaching  his  syringe  to  the  faucet  in 
the  1  ath-room,  and  allowing  the  water  to  flow 
into  the  bowel  with  all  force  in  the  water  pipe. 
He  liad  practised  this  novel  method  of  taking 
an  enema  for  years,  b>it  went  too  far  this  time. 
A  post  mortem  revealed  the  c(;nditions  above 
stated. 

LOWERED  DUTIES  ON  DRUGS. 

'I  he  Senate  tariff  bill  lowers  the  duty  on  a 
ni.mber  of  drugs,  that  on  castor-oil  being  re- 
duced fifty-si.K  per  cent,  below  the  rale  under  the 
McKinley  law,  and  that  on  epsom  salts  thirty- 
four  percent.  Other  reductions  are,  thirty  ])er 
cenc.  on  cod  liver  oil.  fifty  percent,  on  bicarbo- 
nate of  soda,  twenty  jjer  cent,  on  sublimed  sul- 
phur, eighteen  per  cent,  on  refined  camphor, 
and  twenty-five  per  cent,  on  strychnine.  J  he 
duly  on  spectacle  lenses  is  reduced  from  sixty 
to^ihiity-five  per  cent,  ad  valorem,  a  decrease  of 
nearly  forty-two  per  cent. 

A    SUCCESSFUL    WARFARE. 

in  Tlic  Journal  of  llic  151!.  Oct.,  il  was  an- 
nounced that  the  Illinois  Siate  Board  of  Health 
had  begun  a  vigorous  warf.ire  on  the  itinerant 
nostrum  vendors,  "who  annually  fleece  the 
peop'e  of  the  Slate  out  of  a  sum  estimated  at 
more  than  $300000,  by  means  of  brass  bands, 
concert  tioupes,  alleged  Indians  and  other 
moimtebank  attractions."  ;\  t  the  recent 
meeting  of  the  Board,  C)ctn!)oi  1  st  to  2nd,  the 
Secretary,  Dr.  J.  W.  Scf)tt,  reixnied  ihat  there 
was  noi  a  single  one  of  ihese  concerns  now  do 


ing  business  in  the  State;  prosecutions  had 
been  begun  simultaneously  in  every  one  of  the 
102  counties  where  these  itinerants  were 
found,  some  half  dozen  convictions  were  se- 
cured, and  the  rest  folded  their  tents  and  stole 
away — not  silently,  but  with  loud  and  pictur- 
esque profanity  directed  against  the  Illinois 
law  and  its  enforcement. 

MEDICAL  OPINION    AS   TO  THE  USE 
OF  OPIUM  AMONG  THE  CHINESE. 

Dr.  Duncan  Main,  Physician-in-chief  of  the 
large  Mission  Hospital  and  0])ium  Refuge  at 
Hang-(!;how,  gives  in  his  annual  report,  lately 
published,  his  adverse  opinion  of  the  evils  of 
Chinese  opium  smoking  in  very  clear  terms. 
The  ])aragraph  here  quoted  refers  chiefly  to  his 
observations  at  the  Refuge  for  opium  users 
who  ;ipply  for  treatment:  "  During  the  year, 
ninety-seven  who  came  to  us  seeking  to  be  re- 
lieved of  ihe  debasing  habit  received  our  kindly 
help.  The  number  included  ail  grades  of  so- 
ciety and  all  cL.sses  of  men.  My  opinion  about 
the  evil  effects  of  opium  smoking  is  unalleied. 
No  one  in  his  sober  senses  can  say  anything  in 
its  favor,  unless  he  talks  nonsense.  VVe  never 
come  across  an  opium  smoker  or  a  non-opium 
smoker  who  has  an.ything  to  say  in  favor  of  the 
habit,  and  if  it  were  such  an  innocent  affair  as 
some  advocates  of  it  try  to  make  us  believe, 
surely  we  who  live  among  the  pjQp!e  from  year 
to  year  would  find  it  out  I  think  far  too  little 
is  made  of  this  most  important  fact.  Surely 
the  voice  of  the  jieople  should  be  listened  to, 
and  the  testimony  of  those  who  have  paid  fly- 
ing visits  to  opium-smoking  countries  and  gath- 
ered their  information  through  interpreters 
should  be  dir^counted.  Many,  I  fear,  are  in- 
fluenced by  pecuniary  or  pergonal  motives, 
and  some,  no  doubt,  take  up  the  cudgels  for 
it,  because  missionaries  are  its  chief  op])onents. 
To  me  it  seems  an  utter  impossibility  for  any 
one  who  lives  among  the  Chinese,  speaks  their 
language,  knows  tiieir  lives,  and  mixes  wiih 
ihem  from  day  to  day,  to  do  anything  else  but 
condemn'  the  base,  cruel  and  demoralizing 
habit.  It  affects  the  Chinaman's  person,  prin- 
ciple aiid  purse,  damages  his  constitution,  de- 
grades his  conduct  and  drains  his  cash,  and  m 
many  cases  leads  to  ruin  and  destruction  of 
body  and  soid. 

FIVE  CASES  OF   GONORRHcEA   IN 
LITILE  GILRS. 

By  John  Lovett  Morsk,  A.NL.  M.D., 

riiysiciaii  to  oiit-l'iitifiits  at  Uio  Boston  City  llosiiitiil  and 
at  tlio  W»'.st   Kml  Nursery  ami  infants'  liospitai. 

The  following  five  cases  ot  vulvo-vaginitis 
were  observed  during  my  service  at  the  West 
End  Nursery  this  winter.  The  presence  of  the 
gonococcus  was  demonstrated  in  all.  >o  non- 
specific cases  were  met  with  during  this  period. 


THE   CANADA   MEDICAL   RECORD. 


Florence  H.,  five,  was  seen  January  22,  1894. 
She  had  had  a  vaginal  discliarge  for  a  week, 
and  the  external  genitals  were  ( onsiderably 
infliimed  and  excoriated.  No  i)ain  on  mictu- 
rition. She  was  an  only  child,  and  slept  with 
her  parents.  After  some  difficulty  it  was 
ascertained  that  her  father  was  then  under 
treatment  for  gonorrhoea.  The  mother  denied 
infection. 

Gladys  B.,  five  and  ihrce-quarler  years, 
came  under  observation  March  loth.  She  had 
had  a  very  profuse  discharge  from  vulva,  much 
pain  in  micturition  and  pain  in  back  for  ten 
days.  Her  general  health  had  also  somewhat 
deteriorated.  External  genitals  were  very 
much  inflamed  and  excoriated.  Under  treat- 
ment the  urinary  symptoms  ceased  in  a  fort- 
night and  the  external  irritation  in  a  month. 
The  discharge  did  not  entirely  cease,  however, 
until  three  weeks  later.  Two  young  men 
boarders,  who  used  the  same  bath-ioom  and 
sometimes  the  same  towel,  on  being  questioned, 
refused  to  answer,  and  left  the  house.  The 
child  denied  that  she  had  been  tampered  with. 

Antoinette  H.,  two,  began  to  have  a  purulent 
discharge  about  the  middle  of  March,  with 
much  pain  on  micturition.  When  first  seen, 
a  month  later,  the  discharge  had  almost  ceased, 
but  micturition  was  still  very  painful,  the  urine 
often  being  retained  eighteen  or  twenty  hours 
on  this  account.  The  external  genitals  were 
considerably  inflamed,  although  the  discharge 
was  almost  nil.  No  clue  to  the  origin  of  this 
case  could  be  obtained. 

Alice  R.,  five,  was  brought  to  the  nursery  on 
May  9th.  She  began  to  have  a  bloody, 
purulent  discharge  about  the  middle  of 
February,  the  blood  ceasing  in  a  month. 
There  was  a  moderate  vaginal  discharge  at  the 
lime  of  examination,  but  the  external  genitals 
were  but  little  inflamed.  Micturition  had  been 
painful  during  the  first  month.  Her  general 
health  had  suffered  somewhat.  The  probable 
source  of  infection  in  this  instance  was  an  older 
sister  with  whom  she  slept. 

Irene  M.,  two  and  three-quarters,  complained 
of  pain  on  micturition  on  May  7th.  On  examin- 
ation her  mother  found  that  she  was  a  little 
"  chafed."  The  next  morning  she  noticed  a 
greenish  discharge.  The  child  complained  of  a 
great  deal  of  pain  about  genitals  and  in  lower 
abdomen.  When  seen,  May  Tith,  the  genitals 
were  veiy  much  inflamed  and  there  was  a  pro- 
fuse creamy  discharge.  Pain  on  micturition 
and  external  irritation  were  subdued  in  ten  days, 
the  discharge  ceasing  in  about  three  weeks.  No 
source  of  infection,  at  home  or  abroad,  could 
be  discovered  in  this  instance. 

The  occurrence  of  so  many  cases  in  so 
short  a  time  goes  to  show  that  gonorrhoea  is 
certainly  not  uncommon  in  children,  and  the 
fact  that  no  non-specific  cases  were  met  with 
would  seem  to  prove    that    vulvo-vaganitis   in 


children  is  in  the  great  majority  of  cases  of 
gonorrhoeal  origin.  They  also  show  the  diffi- 
culty or  even  impossibility  of  obtaining  a  his- 
tory of  the  infection  in  mnny  cases,  and  hence 
the  importance  of  bacteriological  examination 
of  the  discharge  in  every  case.  In  this  way 
alone  can  a  positive  diagnosis  be  made.  It  is 
to  be  noted  also  that  the  urethra  was  usually 
involved  and  that  the  subjective  symptoms  were 
largely  due  to  this.  The  exte  n  il  irritation 
was  not,  as  a  rule,  very  marked,  and  was  easily 
controlled.  The  vaginal  inflammati  )n,  how- 
ever, was  only  overcome  after  some  time  and 
trouble,  but  gave  rise  to  no  symptoms  other 
than  the  continuance  of  a  slight  discharge. 
—  Archives  of  Pediatrics. 

IN    DERMATOLOGY. 
ByM.  B.  Hartzfxl,  M.D., 

Instructor  in  Dermatology  in  the  Medical  Department 
of  the  University  of  Pennsylvania,  Philatlelphia. 

Case  XX.W.— Erythema  Multiforme. 

Marie  E.,  thirteen  years  of  age.  presented 
herself  at  the  Skin  Dispensary  of  the  Univer- 
sity Hospital  with  an  eruption  consisting  of 
shot  to  pea-sized,  bright-red  papules,  for  the 
most  part  discrete  but  in  a  few  places  confluent, 
situated  upon  the  extensor  surfaces  of  the 
wrists  and  forearms  and  upon  the  backs  of 
the  hands.  The  eruption  was  attended  by 
slight  itching,  and  had  appeared  three  days 
before  the  patient's  visit  to  the  Dispensary. 
A  saturated  solution  of  boric  acid  was  ordered 
to  be  applied  several  times  a  day  for  the  relief 
of  the  mild  pruritus;  no  in.ernal  treatm.ent  was 
cbnsidercd  necessary.  Upon  the  patient's 
return  three  days  later  the  eruption  was  much 
paler,  and  within  a  week  had  completely  disap- 
peared. Eighteen  months  later  the  patient 
again  presented  herself  with  a  new  attack, 
which  differed  in  no  respect  from  the  first  one. 

In  most  cases  of  multiform  erythema  active 
treatment  is  not  necessary,  since  there  are  itw 
or  no  subjective  symptoms,  and  the  eruption 
disappears  spontaneously  in  one  to  three 
weeks. 

The  disease  is  one  readily  recognized,  but 
might  be  mistaken  by  the  inexperienced  for 
papular  eczema  ;  it  differs,  however,  from  this 
affection  by  the  bright-red  color  of  the  lesions, 
their  laiger  si/.e,  and  the  absence  of  severe 
itching. 

Case  XXVI. — Ring-worm  of  the  Scalp. 

E.  C,  a  boy  aged  five,  was  brought  to  me 
for  advice  concerning  a  disease  of  the  scalp 
characterized  by  the  presence  of  numerous 
dime  to  dollar-sized,  circular  patches  partially 
devoid  of  hair,  and  covered  with  fine  grayish 
scales.  While  the  greater  number  of  these 
patches  were  pale,  a  few  of  the  larger  ones 
were  red,  and  dotted  here  and  there  with  small 
pustules.     Upon   close    inspection     numerous 


62 


THE   CANADA   MEDICAL   RECORD. 


short,  broken,  dry,  lustreless  hairs  were  to  be 
seen  which  could  be  readily  extracted  with  the 
forceps.  Examination  of  these  hairs  with  the 
microscope  revealed  large  numbers  of  the 
spores  characteristic  of  ring-worm.  The 
disease  was  of  several  months'  duration,  and 
was  still  spreading.  The  following  ointment 
was  d. reeled  to  be  rubb;d  into  th:  diseased 
portions  of  the  scalp  once  a  day  with  consider,- 
able  friction,  the  hair  having  previously  been 
cut  short  : 


R 


M. 


B.  Naplnhol ^i. 

Petrolati ^vii 


In  addition,  the  entire  scalp  was  to  be 
thoroughly  washed  every  second  day  with  hot 
water  anu  a  superfatted  soap  containing 
sulphur  and  salicylic  acid.  Under  this  treat- 
ment, which  was  most  faithfully  carried  out  by 
the  child's  attendants,  improvement  was  imme- 
diate and  continuous,  and  at  the  end  of  three 
months  the  hair  was  growing  vigorously  and 
no  new  j^atches  were  to  be  found.  As  a  pre- 
cautionary measure,  however,  the  treatment 
was  directed  to  be  continued  for  another  month 
or  SIX  weeks. 

Ring-worm  of  the  scalp  is  an  unusually  ob- 
stinate disease,  and  only  yields  to  the  most 
vioorous  treatment  intelligently  pursued. 
Unless  the  applications  are  well  rubbed  in  so 
that  the  hair-follicles  are  penetrated,  good 
results  are  not  to  be  hoped  for  from  any  form 
of  treament. 

Case  XXVII. — Eczema  Rub  rum. 

J.  B.,  a  boy  three  years  of  age,  was  brought 
to  me  for  the  treatment  of  an  eczema  of  the 
face  and  hands  which  had  existed  for  a  year  or 
eighteen  months.  In  the  face  the  disease 
was  limited  to  the  cheeks,  which  were  bright 
red,  oozing  abundantly  ;  the  hands  were  less 
acutely  inflamed,  the  skin  being  thick  and 
covered  with  crusts.  The  itching  was  intense, 
occurring  in  jjaroxysms  during  which  the  little 
patient  was  uncontrollable,  and  scratched  his 
face  until  it  was  raw  and  bleeding.  Ointments 
many  and  various  were  prescribed  from  time  to 
time,  but  these  not  only  failed  to  impiove  the 
condition  of  the  skin  but  invariably  increaseJ 
the  itching,  so  that  this  form  of  treatment  had 
to  be  abandoned.  The  local  treatment  was 
finally  limited  to  the  use  of  lotions,  and  of 
these  the  familiar  calamine  lotion  proved  of 
great  service  during  the  moist  stages  of  the 
disease.  When  the  oozing  had  ceased  and 
the  skin  had  grown  paler,  a  lotion  containing 
five  drops  of  the  liquor  carbonis  detergens  to 
the  ounce  of  water  was  used  with  decided 
benefit,  relieving  the  itching  and  lessening 
hyperemia.  After  several  months  of  patient 
and  careful  treatment,  which  was  practically 
limited   to  the  employment  of  the  above  men- 


tioned lotions,  varied   in   strength  according  to 
circun.stances,  a  cure  was  effected. 

As  a  rule,  ointments  are  far  more  serviceable 
in  the  treatment  of  cutaneous  diseases  than 
any  other  form  of-application  ;  but,  as  the 
foregoing  case  iilus; rates,  occasionally  facts  of 
every  kind  disgree.  In  such  cases  we  must 
limit  ourselves  to  ','ie  use  of  lotions  or  the 
gelatine  picpara  0,3  di  vised  by  Unna  and 
others  ;  and  aliiough  these  often  succeedadmir- 
ably,  yet  they  can  scarcely  be  regarded  as 
entirely  replaci;iii  greasy  applications  in 
effective'-H-ss.  Pa  ients  in  whom  this  idiosyn- 
crasy exists  are  apt  to  require  long  treatment 
and  careful  dis^criminauon  in  tiie  choice  of 
remedies .  — Arci.  ivcs  of  Pediatrics. 

TIPPLING. 

The  Catholic  School  Commissioner  for  the 
Province  of  Quebec,  Prof.  Brennan,  of  the 
Laval  University,  and  a  prominent  practi- 
tioner of  Montreal,  in  an  address  before  the 
/American  Public  Health  Association  last  week, 
said  that  from  his  medical  experience  he  was  in 
a  position  to  say  that  in  women  the  habit  of 
tippling  was  far  more  prevalent  and  disastrous 
than  is  imagined ;  within  the  last  four  months 
-he  had  seen  four  women,  each  the  mother  of 
several  children,  and  moving  in  good  society, 
die  from  the  effects  of  chronic  alcoholism.  Dr. 
Brennan's  experience  can  be  duplicated  by, 
probably,  four  out  of  every  five  general  prac- 
titioners in  the  United  States, — not  among 
women  alone,  but  far  more  frequently  among 
men.  And  no  wonder  when,  as  shown  by  the 
figures  of  the  Internal  Revenue  Commissioner 
for  the  year  1893,  the  sixty-five  odd  millions, 
comprising  the  population  of  this  country,  con- 
sumed 88,777,187  gallons  of  alcoholic  spirits 
and  1,054,785,376  gallons  of  beer  during  the 
year.  These  gallons  would  make  more  than 
6,000,000,000  drinks  of  whisky  and  nearly 
13,000,000,000  glasses  of  beer,  for  which  there 
was  paid  to  the  barkeeper  $1,226,758,000.  The 
naked  figures  are  sufficiently  eloquent  of  the 
resultant  amounts  of  misery,  disease  and  pre- 
mature death. —  The  Journal  Am.  Med  Assn. 

IN  OTOLOGY. 
By  J,  OscROFT  Tanslev,  M.D., 

Assistant  Surgeon  to  the  Manliattan  Eye  and  Ear  Hospital 
New  York. 

Case  XI. — A  Unique  Foreign  Body  in  the 
Ear. 

January  16,  1892,  P.  M.,  age  five  years, 
was  brought  to  me  by  his  mother,  who  was  in  a 
very  nervous  condition,  saying  that  he  had 
lost  a  valuable  diamond  in  his  ear,  and  she 
wished  me  to  extract  it.  She  said  that  she 
permitted  him  to  examine  and  play  with  her 
jewelry  at  times,  to  amuse  him,  and  that  the 
day  before,  while  playing  with  one  of  her  rings, 


tu'E  CANADA  Medical  record. 


63 


the  stone  had  disappeared,  and  he  said  it  was 
in  his  ear.  She  examined  the  ear  and  saw  it 
glisten,  and  tried  to  extract  it,  but  failed,  and 
pushed  it  in  out  of  sight. 

She  seemed  fully  as  solicitous  about  her 
diamond  as  about  his  hearing,  and  was  anxious 
to  have  me  succeed  in  its  extraction.  I  chloro- 
formed the  boy,  and  by  the  use  of  a  fine  fenes- 
trated non-cutting  curette,  carefully  passing  it 
above  and  behind  the  stone,  and  using  delicate 
traction,  first  upon  one  side  and  then  upon  the 
other,  I  soon  had  the  diamond  in  my  hand. 
It  certainly  was  a  brilliant  one,  but  1  did  not 
test  for  its  purity. 

The  drum  was  not  injured  in  the  slightest, 
and  the  canal  had  only  one  abrasion,  and  that 
was  of  little  importance.  There  was  no  after- 
trouble. 

Case  XII. — Siitpurative  Mastoiditis  from 
Suppurative  Otitis  Media. 

April  30,  1894,  W.  K.,  age  two  years,  has 
had  a  discharge  from  the  left  ear  for  about  a 
month,  caused  seemingly  by  teething  ;  did  not 
have  much  jmin  or  annoyance, and  was  as  usually 
playful  during  the  day.  Ten  days  ago  lie  began 
to  complain  of  the  left  ear  when  touched,  and 
would  cry  when  it  was  washed  or  pressed  in 
any  way,  and  would  not  lay  upon  that  side.  It 
soon  became  swollen  and  red  behind,  and  the 
ear  was  pushed  forward  and  outward  very 
markedly,  and  this  it  was  which  caused  the 
mother  to  bring  the  child  to  me.  The  tender- 
ness—  which  was  not  very  marked — and  the 
swelling  behind  the  ear  was  of  but  little  conse- 
quence to  them,  because  it  was  evidently  the 
result — so  they  said — of  his  teething  ;  and  ihe 
discharge  from  the  ear  was  to  them  also  but  a 
simple  matter,  because  "  teething  children  were 
apt  to  have  discharges  from  the  ears."  So  they 
contented  themselves  with  occasional  injections 
of  chamomile  tea  ;  but  the  unseemly  appearance 
caused  by  the  ear  standing  out  so  from  the 
head  was  of  great  importance,  and  my  assis- 
tance was  sought  for  a  cosmetic  purpose 
rather  than  a  medical  one. 

Examination  showed  the  canal  full  of  bloody 
pus,  and  when  this  was  cleared  away,  a  perfor- 
ation was  found  in  the  drum  posteriorly.  'J  he 
mastoid  was  largely  swelled  from  the  apex  to 
well  upon  the  temporal  bone.  Fluctuation 
was  present,  but  the  tissues  were  so  densely 
swelled  that  it  was  difficult  to  decide  positively 
upon  fluctuation.  The  parents  were  extremely 
shocked  when  I  told  them  of  the  imme- 
diate necessity  for  operation  ;  but  when  I  point- 
ed out  to  them  that  this  swelling  was  really 
the  same  as  a  "  fever  sore  "  upon  the  leg,  they 
at  once  permitted  me  to  do  what  was  necessary. 

I  chloroformed  the  child,  and  then  made  an 
incision  from  the  apex  of  the  mastoid  upward 
to  the  level  of  the  pinna,  and  following  the 
general  direction  of  the  curve  of  the  auricle. 
The  cut  was  two  and  a  half   inches  long,   and 


fully  one  and  one  quarter  deep.  I  liberated 
about  three  drachms  of  laudable  pus,  and  was 
able  to  pass  the  probe  throjgh  a  small  opening 
in;o  the  antrum  mastoiditis.  The  wound  was 
tented  with  iodoform  gauze  and  covered  with 
a  poultice,  oil  silk,  and  bandage— and  the  direc- 
tions were  to  change  the  poultice  every  two 
hotirs  and  syringe  the  ear  with  water  as  warm  as 
can  be  borne  at  the  same  time. 

May  I  St. — The  cliild  seems  much  improved. 
There  is  no  dischage  from  the  ear,  but  a  co[iious 
one  from  the  wound.  Directions  were  to  con- 
tinue as  before  with  poultice  and  douche,  remov- 
ing and  replacing  the  tent  with  a  new  one 
twice  daily. 

May  17th. — The  child  has  been  seen  daily, 
and  the  wound  has  been  probed  and  tented  to 
prevent  healing  at  its  external  lips  and  to  insure 
granulation  from  the  bottom.  The  tents  have 
been  gradually  forced  outwards  by  the  granu- 
lations, and  to-day  it  is  impossible  to  insert 
one,  the  wound  being  filled  and  is  rapidly  cica- 
trizing. The  poultice  has  been  to-day  discon- 
tinued, an  1  replaced  by  a  fold  of  iodoform- 
gauze,  and  instruction  given  to  daily  lessen  the 
amount  of  dressing  and  bandage.  The  perfor- 
ation in  membrana  tympani  is  entirely  healed, 
and  there  has  been  no  discharge  from  it  since 
the  second  day  after  the  operation. — Archives 
of  Pediatrics. 

SEPTICEMIA       DURING         SCARLET 

FEVER,    IMPLICATING    SEVERAL 

JOINTS  AND  CAUSING  NECROSIS 

OF  THE  CLAVICLE. 

The  patient  was  a  girl,  six  years  old,  and  the 
scarlet  fever  ran  an  ordinary  course,  until 
during  the  second  week,  when  she  developed 
a  purulent  otitis  on  both  sides.  The  next  week 
the  temperature  suddenly  went  up  to  105.20  F., 
and  the  phalangeal  joint  of  the  right  great  tee 
became  swollen  \  and  the  next  day  the  right 
elbow  joint  and  the  right  hip  were  in  the  same 
condition, — swollen  and  painful.  All  three 
joints  were  opened  and  creamy  pus  evacuated, 
and  all  three  joints  eventually  became  anchy- 
losed.  Abscesses  also  formed  underneath  the 
periosteum  of  both  mastoid  processes,  and 
about  this  time,  without  any  abscess  appearing, 
the  sternal  end  of  the  left  clavicle  became  pro- 
minent and  ulcerated  through  the  skin.  This 
end  of  the  clavicle  became  necrosed,  and  was 
finally  removed.  The  child  eventually  recovered 
with  an  anchylosed  elbow  and  hip,  and  a  cla- 
vicle that  is  shorter  and  more  irregular  than  the 
right  one. — Dime  an  Macartney  {Glasgow 
Med.  /ourn.). 

FOREIGN  BODY  IN  THE  OESOPHAGUS. 

A  child,  four  and  a  half  years  old,  was 
brought  for  relief  from  suffocative  symptoms 
following  the  swallowing  of  a  copper  cent.     As 


64 


THE  CANADA  MEDICAL  RECORD. 


the  urgent  symptoms  quickly  subsideJ,  it  was 
iho'.ight  b(st  not  to  interfere  actively, 
and  simple  measures  were  therefore  t.ikcn 
to  favor  the  descent  of  the  foreign  body 
and  to  expedite  its  expulsion  from  the  bowel. 
Four  days  later,  suffocative  symptoms  again 
appeared,  and  ihe  child  complained  of  a  sensa- 
tion of  discomfort  in  the  chest.  This  passed 
off,  and  nothing  more  was  noticed  for  another 
forly-eight  h.>ur5.  The  coin  could  be  felt  at 
the  jiinclion  of  ihe  lower  and  middle  thirds  of 
the  ce-;ophagus,  and  before  -esorting  to  an 
operation  it  was  determined  to  attempt  to  di  ;- 
lodge  it.  A  sm.iil  sized  sound  was  introduced 
into  the  sloninch,  and  through  it  was  j)assed  a 
four-ounce  mixture  of  syrup  of  ipecac  and 
water.  During  the  emesis  thus  provoked,  the 
sound  was  gentiy  withdrawn,  and  the  coin 
catching  in  its  edge  was  dislodged  and 
expelled  with  the  vomited  fljid. — Fcli-et  (^Le 
Bulletin  Medical). 

IGNIPUNC'IURK  IN   TUBERCULAR 
ARTHRITIS. 

The  treatment  of  tubercular  joint  disease  by 
intra-cellular  ignipiincture  was  formerly  in 
common  employment,  but  was  difficult  of  appli- 
cation, owing  to  the  fact  that  it  was  necessary 
to  use  the  actual  cautery  with  thick  points. 
Now,  however,  the  tliermocaulery  and  electro- 
cautery, with  their  finely  pointed  tips,  make  the 
operation  one  of  .such  ease  of  execution  tliat 
the  writer  urges  its  revival  in  the  therapeutics  of 
articular  affections.  He  reports  eight  cases, 
children  from  two  to  six  years  of  age,  treated 
in  this  way.  In  five  of  these  cases  a  complete 
cure  was  obtained  in  from  four  to  five  months, 
and  the  remaining  three,  though  not  yet  cured 
at  the  time  the  report  was  made,  were  in  such 
a  good  condition  that  there  was  eveiy  reason 
to  look  for  a  favorable  result.  Kirmisson 
insists  upon  the  absolute  necessity  of  beginning 
the  treatment  by  ignipunciure  in  the  early 
states  of  the  disease  while  tiie  skm  is  still 
intact  and  before  abscesses  liave  formed  and 
opened,  leaving  fistulous  tracts.  In  cases  of 
local  tuberculosis,  in  which  abscesses  had 
formed  or  been  opened,  the  results  of  this  mode 
of  treatment  were  not  nearly  as  favorable  as  in 
the  cases  here  reported.  —E.  Kirmisson 
(  U  Unio7i  Medic  ale), 

suppuration  of  the  middle  ear 

due  to  a  coffee  bean  in  the 

nosf:. 

The  patient,  a  girl  three  years  old,  had  a 
running  car  for  two  months,  which  apjieared 
one  month  after  a  purulent  nasal  discharge 
from  the  left  side.  A  coffee  bean  was  found 
in  the  left  nostril.  Tiiis  was  removed,  and  all 
the  symptoms  promptly  disappeared.  In  four 
days  there  was  no  trace  of  i)us  in  the  ear,  and 


the  discharge  from  the  nose  had  nearly  stopped. 
In  a  w  ck  the  nas  il  discharge  was  normal. 
The  almost  immediate  ce-sation  of  the  aural 
di>chaige  after  the  removal  of  the  irritating 
fa:tor  shows  the  importance  of  carefully  exxm- 
ining  the  nose  and  nasopharynx  in  all  cases 
of  aural  distuibances. — M.  D.  Lederman, 
Nciv  York  C  \/cd.  Rec). 

THE  METHDD  OF  BRAND  IN   FHE 
TRE.ATMENT  OF  TYPHOID  FEVER. 

'•  If  the   diagnosis  of  typhoid  fever  is  proba- 
ble, recourse  should  be  had  to  the  baths,  what- 
ever   may    bo    the  symptoms.      The  full    tub 
should    be    placed  in     the    ward    or    chamber, 
parallel  to  the  bed,  at  a    distance  of  one  or  two 
metres,    tlie    floors   properly    protected  by  oil- 
cloth, and  a  screen  placed  between  the  bed  and 
the  bath-tub.     A    sufficient    quantity    of  water 
should  be  used  to  cover    the  patient's    body  to 
the   neck.     It  shoul  1    be    of  a    temperature  of 
from   64.4^  to   68"^    F.  (18°  to  20°  C).      The 
baths  should  be    prei)ared  without  disturbance 
or  noise.    There  should  be  placed  on  the  floor, 
near   the  head  of  the  tub,  two  pitchers  of  cold 
water  of  a  temperature  of  from  46.4°  to  50"  F. 
(8*^  to    10°   C),   each   contahiing  four  or  five 
quarts  (litres).     A  glass  of  water  shojld  be  at 
hand.     The    first  bath  should  be  given  prefer- 
ably about  four  o'clock  in  the  afternoon,  unless 
there  is  some  urgent  reason  for  selecting  a  dif- 
ferent hour,  and  the    physician    should  be  pre- 
sent,    'i'he   rectal    temperature    is   taken,    the 
urine  is  voided,  and  the  patient  is  assisted  into 
the    full  tub,  the  screen    having  been  removed. 
If  there  is  perspiration,  the  patient   is  dried  be- 
fore entering   the  bath.     Cold  water    from  the 
pitchers  is  poured  upon  tlie  head  and  the  back 
of  the  neck  for  one  or  two  minutes,  theannunt 
being  from  two  to   three  quarts  (litres).     Then 
a  s>vallow  of  cold  water  or  red  wine  is  given. 
This  being  done,  the  whole  surface  of  the  body 
is  briskly  rubbed  with  a    sponge  or  brush,  and 
the   patient  is   made  to  rub    his  abdomen  and 
chest.     These  frictions  stimulate  the  peripheral 
circulation,    prevent    the  accumulation  of  heat 
at    any    one   point,    moderate  the  sensation  of 
cold,    and   help  to  pass  the  time;  ihey  are  not 
indi>pensable.     Shivering  aj)pears,  as  a  general 
rule,  in  between  eight  and  twelve  minutes  ;  this 
is  a  necessary  evil,  to  which  too  much  attention 
is  not  to  be  paid.     Toward    the    middle  of  the 
bath,  or  at  its  termination,  cold  water  is  again 
poured   over  \.\\t    head  and   neck.     The  time 
occupied  ought  to  be  at   least  fifteen    minutes, 
longer  if  the  head  is  still  warm  and  the  cheeks 
red,  or  if  the   temperature  of  the  ]iatient  was 
very  high  before  the  bath. 

"The  patient  should  leave  the  bath  without 
precipitation,  fie  cannot  take  cold  ;  thoracic 
complications  are  caused  by  typhoid  fever  and 
not    by    chilling.      The    air   of  the   apartment 


THE  CANADA   MEDICAL   RECORD. 


6S 


sliould  be  piiie  and  not  too  warm  ;  the  win- 
dow should  be  opened  in  the  intervals  between 
the  baths  ;  during  the  bath  it  ought  to  be  closed. 
On  leaving  the  bath,  the  patient  should  be 
gently  dried  with  a  towel.  The  bed  should  be 
carefully  made  during  each  bath.  Ifonre- 
turniuii  to  the  bed  shivering  takes  place,  the 
limbs  should  be  rubbed  and  a  hot  bottle  placed 
at  the  patient's  feet.  A  cold  compress,  cover- 
ed with  oil-silk  or  flannel,  should  be  placed 
over  the  abdomen,  and  a  little  warm  nourish- 
ment administered.  It  is  not  necessary  to  re- 
new the  water  of  the  ba'h  every  three  hours; 
once  in  twenty-four  hours  is  sufificient.  As  a 
rule,  the  patient  should  pass  his  water  before 
entering  the  bath. 

"  Three-quiirters  of  an  hour  after  the  bath, 
the  rectal  temperature  should  again  be  taken. 
If,  however,  it  is  found  to  be  below  ioi°  F. 
(38.5°  C.)  it  is  not  necessary  to  take  it  again 
for  three  hours. 

"  Alimentation  should  consist  of  the  follow- 
ing articles  :  Milk  diluted  with  coffee  or  tea  or 
cocoa  (a  quarter  of  a  litre  at  each  administra- 
tion) ;  thoroughly  cooked  grr.el,  oatmeal,  tapi- 
oca, or  vermicelli ;  veal,  mutton,  or  chicken 
broih  freed  from  fat  when  cold  and  reheated 
at  the  moment  of  administration.  As  a  drink, 
pure  cold  water  should  be  given  ;  the  indication 
for  wine  or  spirits  is  urgent  only  in  cases  that 
are  subjected  to  this  treatment  late  in  their 
course.  If  the  patient,  does  not  sleep  or  sleeps 
badly,  he  is  to  have  a  draught  of  iced  water, 
and  the  abdominal  compress  is  to  be  changed 
every  quarter  of  an  hour.  The  discharges 
from  the  bowels  are  to  be  preserved  for  inspec- 
tion, and  the  total  quantity  of  urine  may  be 
collected  in  the  same  vessel.  Neither  age,  sex, 
menstruation,  pregnancy,  nor  sweating  (except 
that  which  occurs  at  the  end  of  defervescence) 
in  any  way  modifies  the  treatment.  In  women 
who  are  weaning  their  children,  cold  compresses 
should  be  a|iplied  to  the  breasts,  and  frequently 
renewed.  If  diarrhoea  persists,  it  is  to  be  com- 
bated by  cold  compresses,  which  may  be  kept 
cold  by  the  aid  of  a  bladder  of  ice.  If  there  is 
constipation,  it  is  to  be  treated  by  cold  ene- 
mata  ;  and  if  these  fail,  by  enemata  consisting 
of  one  part  of  cold  water  and  one  part  of  fresh 
ox-gall. 

"  When  the  temperature  before  the  bath  is 
very  high,  or  if  the  fall  forty-five  minutes  after 
the  bath  is  less  than  i.S°  F.  (1°  C),  the  bath 
must  be  prol  nged  to  eighteen  or  twenty  min- 
utes. It  is  very  rarely  necessary  to  modify  the 
general  formula.  After  the  temperature  do:s 
not  exceed  102.2°  F.  (39°  C),  but  yet  reaches 
101°  F.  (38.5°  C),  it  is  necessary  to  treat  these 
slight  exacerbations  by  baths  68°  F.  (20°  C), 
and  of  five  minutes'  duration,  in  order  to  pre- 
vent the  prolongation  of  the  fever  or  the  occur- 
rence of  relapse,  and  to  shorten  convalescence. 
If  relapse  occurs,  it  must  be  treated  according 


to  the  general  fwraiuLi.  When  the  temperature 
no  longer  exceeds  101°  F.  (38.5°  C),  defer- 
vescence being  established,  the  baths  are  dis- 
continued, and  the  patient  should  be  treated 
as  convalescent,  but  is  to  be  kept  in  bed  until 
the  temperature  has  not  exceeded  100,4°  F. 
(38°  C.)  for  four  days.  He  may  then  rise, 
and  in  a  short  time  walk  in  the  open  air  ,  he 
may  prolong  his  promenades  according  to  his 
strength,  and  one  will  be  struck  by  the  rapid- 
ity with  which  his  strength  increases  after  every 
outing.  Pro[)er  precautions  are  to  be  taken 
against  cold.  As  to  alimentation,  already 
during  defervescence  there  may  be  added  to 
his  soup,  inilk,  or  bouillon  either  one  or  two 
raw  eggs  daily,  or,  a  little  later,  one  or  two  tea- 
spoonfuls  of  scraped  raw  meat  or  a  little  toasted 
bread  or  biscuit,  but  the  aliment  must  always 
be  given  in  liquid  form." — Glenard. 

NITRATE  OF  STRYCHNINE  IN   ALCO- 
HOLISM. 

From  the  results  obtained  in  twenty-five 
cases,  we  can  learn  that,  simultaneously  with 
the  use  of  this  remedy,  the  craving  for  alcohol 
in  inebriates  diminishes,  and  in  a  few  days  is 
completely  gone,  and  through  the  withdrawal 
of  the  poisonous  beverages  and  the  tonic  effects 
of  the  strychnine  there  is  a  more  or  less  rapid 
restoration  to  sound  physical  health  and  of  the 
mental  powers  ;  but  as  most  of  those  treated 
have  relapsed  within  from  one  to  eleven 
months,  the  inhibiting  power  of  the  remedy  is 
not  permanent,  and  while  it  temporarily  relieves 
the  distressing  and  overwhelming  craving  for 
more  stimulant  and  promotes  a  return  to  nor- 
mal health,  in  which  condition  the  patients  may 
continue  to  remain,  yet  they  still  lack  the 
necessary  will-power  to  enable  them  to  avoid 
the  dangers  which  they  know  will  precipitate  a 
return  to  their  previous  enslaved  and  degraded 
condition.  So  that,  while  it  is  fully  within  the 
power  of  medical  science  to  restore  these  pa- 
tients to  temporary  health,  strychnine  does  not 
— as  doubtless  no  drug  treatment  ever  will — 
prevent  the  possibility  cf  further  relapses, 
although  we  can  always  depend  on  it  to  arrest 
what  would  be  a  prolonged  debauch  if  its  aid 
is  early  resorted  to.  That  weakened  will 
power  is  a  result  of  a  prolonged  use  of  alcohol 
is  generally  conceded,  as  is  the  fact  that  the 
tendency  to  alcoh  )lism  is  in  a  large  percentage 
of  cases  inherited,  audit  is  often,  as  dipsomania, 
one  of  the  manii'estaiions  ofinsuiity;  that  a 
definite  series  of  pathological  conditions  follows 
the  continued  indulgence  in  alcohol,  diff.'ring 
only  in  degree  in  the  case  of  the  milder  methyl 
to  the  powerful  effects  of  amy!  alcohol,  the 
nervous  system  showing  the  earliest  and  most 
marked  disturbance,  although  every  organ  and 
tissue  in  the  body  cventuallv  suffers.  These 
and   many  other  facts  have  led  neurologists  to 


66 


THE  CANADA  MEDICAL  RECORD. 


place    alcoholism    as  a  distinct    disease  among 
the  neuroses. 

This  position  implies  a  complete  revolution 
in  the  methods  of  treating  these  cases,  and  has 
brought  to  the  aid  fif  philanthropists  and  moral- 
ists the  assistance  of  the  medical  profession, 
upon  whom  now  devolves  the  duly  of  further 
elucidating  the  true  pathology  of  the  disease 
and  indicating  the  best  means  of  restoring  this 
numerous  class  of  patients  to  a  normal  condi- 
tion. 

That  the  urgent  demand  for  relief  from  the 
evils  of  intemperance  is  being  recognized  by 
the  profession  is  evidenced  by  the  increased 
interest  taken  in  the  work  of  the  American 
Association  for  the  Study  and  Cure  of  Inebriety, 
and  in  the  Section  for  the  Study  of  Inebriety  of 
the  British  Medical  Association,  and  by  an  ever- 
increasing  number  of  scientific  investigators 
throughout  the  world. 

Before  rational  and  effective  measures 
can  be  adopted  for  the  proper  management  of 
inebriety,  we  must  have  correct  opinions  in 
regard  to  the  physiological  actions  of  alcohol 
and  the  pathology  of  the  disease ;  otherwise 
we  must  trust  to  the  empirical  results  of  expe- 
rience. 

The  chief  action  of  alcohol,  then,  is  to  paralyze 
the  vaso-motor  system,  diloting  the  arteries. 
Strychnine,  besides  exalting  the  ex'itability  of 
the  spinal  cord,  and  probably  the  motor  centres 
in  the  brain,  stimulates  the  vaso-motor  centres, 
contracting  the  arterioles,  as  well  as  being 
one  of  the  most  efficient  heart  tonics  through 
its   stimulating  effects  on  the  cardiac  ganglia. 

While  we  have  in  strychnine  a  true  anta- 
gonist to  the  action  of  alcohol  and  one  that 
will  counteract  its  effects,  the  inebriate  still 
requires  aid  which  can  scarcely  be  expected  of 
drugs  ;  he  needs  the  mental  and  will-power  to 
overcome  his  acquired  or  inherited  tendency  to 
resort  to  narcotics.  This  must  come  from 
treatment  which  seeks  first  to  restore  all  the 
abnormal  conditions  of  the  patient,  whether 
due  to  alcohol  or  otherwise  ;  then  strict  absti- 
nence must  be  maintained,  tlie  patienc  being 
aided  by  moral  suasion,  the  diversion  of  con- 
tinual employment,  and  the  education  of  the 
mental  and  moral  focultics  to  a  higher  status  ; 
even  the  influence  of  hypnotic  suggestion  may 
be  applied  in  suitable  cases,  as  has  been  done 
recently  with  a  fair  measure  of  success  ;  and, 
where  these  means  fail,  then  institutions  where 
voluntary  or  forced  detention  can  be  fecured, 
and  where  all  the  prcircnt  known  means  can  be 
most  successfully  applied,  must  be  the  only 
hope  of  restoring  the  unfortunate  subjects  of 
narcomania. —  Therapeutic    Gazette. 

TIC  DOULOUREUX. 

Dr.  Jarre  presented  a  report  on  the  causation 
and  treatment  of  tic  douloureux  of  tlie  face.   His 


coiiciu5ioii.->  a.u  a..s  ioiiuvvs  {^La   'Tribii?ie  Medi- 
cal e)  : 

1.  The  disease  known  as  spasmodic  neur- 
algia, epileptiform  neuralgia,  tic  douloureux  of 
the  face,  etc.,  is  due  to  a  peripheral  lesion 
seated  in  the  terminal  extremities  of  the  fifth 
pair. 

2.  The  exact  and  invariable  seat  of  this 
lesion  is  a  more  or  less  extensive  portion  of  the 
alveolar  border  of  the  upper  or  lower  jaw, 
which  is  the  seat  of  a  cicatrix  consecutive  to 
former  accidents  of  different  kinds. 

3.  The  intracicatricial  location  of  the  ori- 
ginal lesion  brings  tic  douloureux  into  the  same 
category  as  the  neuralgia  of  the  toothless,  and 
the  neuralgia  affecting  the  stumps  of  amputated 
limbs,  both  of  which  are  also  of  cicatricial  origin. 

4.  The  rational  treatment  of  tic,  therefore, 
ought  to  consist  purely  and  simply  of  the  abla- 
tion of  that  poriion  of  the  alveolar  border  com- 
prising the  original  seat  of  the  disease. 

5.  The  ablation  is  done  by  first  incasing  the 
soft  parts  with  the  galvano-cautery  knife,  remov- 
ing the  alveolar  border  by  the  bone  forceps  or 
saw,  and  subsequently  rasping  the  wound  in 
the  bone. 

6.  The  operation  is  not  at  all  grave  ;  the 
wound  dressed  antiseptically  heals,  ordinarily, 
in  a  few  weeks  without  complications. 

7.  The  results  so  far  obtained  give  reason 
to  hope  that  we  are  now  in  possession  of  a 
simple,  rapid  and  harmless  means  of  curing  tic 
douloureux,  a  disease  which,  up  to  the  present, 
has  been  classed  with  incurable  diseases. — 
Dommion  Medical  Monthly. 


A   BLOODLESS  OPERATION 
HEMORRHOIDS. 


FOR 


Manley  {^Boston  Afedical  and  Surgical  Jour- 
nali  February  i,  1S94)  describes  his  bloodless 
method  of  treating  hemorrhoids.  A  brisk  pur- 
gative is  given  the  evening  before  the  opeiation. 
Before  opeiating,  two  to  four  ounces  of  whiskey 
are  administered,  and  effeciive  cccainization  ap- 
plied hypodermically.  Anal  dilataiitn,  gradual 
and  steady,  without  rupture  of  the  muscle,  is 
done,  and,  after  drying  and  mojiping  with  co- 
caine solution,  each  hemorrhoid  is  separately 
seized,  close  to  its  base,  firmly  between  the  tip 
of  the  thumb,  index  and  middle  fingers.  It  is 
put  on  full  stretch,  then  twisted,  and  finally  so 
comj^letely  crushed  that  it  is  reduced  to  a  pulp, 
and  none  of  the  investing  tunics  remain,  except 
the  mucous  membrane  and  its  undei  stratum  of 
fibrous  tissue.  The  mass  is  then  returned,  and 
ai^  opium  suppository  introduced.  He  has 
treated  thirty-two  cases  in  this  way  with  jier- 
fectly  satisfactory  results. 


THE  CANADA  MEDICAL  RECORD. 


67 


THE  CANADA  MEDICAL  RECORD 

Published  Monthly. 


Su'is-iifilmn  Price,  $1.00  per  annum  in  adnance.     Single 
Cojiies,  10  c/a-. 

EDITORS  : 

A.  LAPTHOfl:;SMirH,  B.A.,M.D.,iyi.R.C.S.,Eng..F.O.S. 

London. 
F.  WAYLAND  CAMPBELL,  M.A.,  M.D-.L.R.C.P.,  London 

ASSISTANT  EDITOR 
EOLLO  CAMPBELL.  CM.,  M.D. 

Make  all  Clieqnes  or  P.O.  Money  Orders  for  subscription  or 
advertising  payable  to  JOHN  LOVELL  &  SON,  23  St.  Nicho- 
las Street,  Montreal,  to  wliora  all  business  communications 
should  be  addressed. 

All  letters  on  professional  subjects,  books  for  review  aiid 
exchanges  should  be  addressed  to  the  Editor,  Dr.  Laptlioru 
Smith,  248  Bishop  Street. 

Writers  of  original  communications  desiring  reprints  can 
have  them  at  a  trifling  cost,  by  notifying  JOHN  LOVKLL  & 
SON,  immediately  on  the  acceptance  of  their  article  by  the 
Editor. 

MONTREAL,  DECEMBBE,  1894. 


WHO  OWNS  THE  DOCTOR'S 
PRESCRIPIION? 
One  would  hardly  think  that  this  question 
could  come  up  again  after  having  been  decided 
in  favor  of  the  patient  by  the  courts.  It  is  true 
that  quite  recently  a  judge  in  New  York  has 
ventured  to  decide,  contrary  to  precedent,  that 
the  prescription  was  only  good  for  one  pack- 
age of  medicine,  and  was  not  transferable  ;  but 
we  doubt  whether,  if  his  decision  should  be 
taken  to  appeal,  the  higher  courts  would  not 
reverse  it,  and  decide,  as  it  has  generally  been 
decided,  that  once  the  doctor  has  allowed  the 
prescription  to  pass  from  his  hand  he  has  no 
further  control  over  it.  Such  is  also  the  opinion 
of  leading  lawyers  in  this  city,  and  it  appears  to 
be  the  opinion  of  the  public  and  of  most,  though 
not  of  all,  the  druggists.  It  matters  not  whether 
the  patient  has  ever  paid  the  doctor  for  the 
prescription  or  not ;  it  matters  not  whether  the 
prescription  contains  opium  or  other  drugs 
which  it  would  not  be  for  the  welfare  of  the  pa- 
tient to  continue  taking ;  it  does  not  even 
matter  whether  the  druggist  dispenses  it  to  his 
regular  customers,  who  thereby  save  the  ex- 
pense of  consulting  the  doctor,  who,  however, 
has  no  other  means  of  obtaining  his  livelihood 
unless  by  the  consultation  fees  of  these  very  pa- 
tients; the  patient  has  the  right,  which  is  con- 
stantly being  exercised,  to  not  only  cure  himself 
but  also  to  cure  a  hundred  of  his  friends  with 
this  one  prescription.  What  diff.^-ence  does  it 
make  whether  the  doctor  receives  anything  for 


his  services  or  not  to  these  ninety-nine  suffering 
citizens  ?  They  want  to  be  cured  cheaply  ;  their 
friend  has  the  prescription,  and  the  druggist  is 
paid  for  his  medicine,  and    both  these   parties 
are  satisfied.     It  does  not  seem,  however,  that 
the  doctor  is  quite  so  well  pleased,  for  an  asso- 
ciation has  lately  been  formed    in  Montreal  to 
protect  the  interests  of  the  physicians,  and  this 
association  has  among  other  things  decided  to 
ask  for  legislation  to  prevent  the  druggist  from 
filling  a  prescription    more  than   once.     In  re- 
ferring to   this  matter   editorially,  the  Toronto 
Afai/  voices  the  opinion  of  the  public  when  it 
says  :  "  The  result  of  this  would  be  to  increase 
materially  the  receipts  of  doctors,  since  it  would 
be  necessary  to  pay  for  a  fresh  prescription  each 
time  the  medicine  was  required  to  be  duplicated. 
If  such  a  proposal  is  entertained,   which  is   ex- 
tremely unlikely,  it  might  as  well  be  abandoned, 
since  the  legislature  would  not  consider  it  for  a 
moment."  We  quite  agree  with  our  laycontempo- 
rary.   Any  doctor  who  thinks  himself  aggrieved 
by  a  patient,   who  has  paid  him  nothing  for  his 
prescription,  magnanimously  handing  it  around 
to  all  his  friends,  without  even  mentioning  the 
good  doctor's  name  to  them,  has  the  remedy, 
and  a  very  simple  one,  in  his  own  hands.  This  is 
nothing  more  or  less  than  to  stop  writing  pre- 
scriptions.    The  prescription  has  been  grossly 
abused  by  both  patients  and  druggist;  and  when 
a  doctor   finds  that  he   is  prescribing  himself 
out  of  practice,  he  had  better  stop  prescribing. 
His  mission  on  earth  is  to  relieve  suffering  and 
to  prolong  life ;  how  he   best  may  fulfill  it  is  a 
matter  for  himself  to  decide.     For  the  busy  phy- 
sician who  has  no  time  to  eat  or  sleep,  it  is  cer- 
tainly a  great  convenience  to  send  his  patients 
to  the  drug  store  to  get   their  medicine,  and  it 
makes  very  Httle  difference  to  him  if  a  few  hun- 
dred intending  patients  are  thereby  enabled  to 
dispense  with  the  formaUty  of  paying  him  a  fee. 
But  this  is   apparently  not  the  case    with    the 
doctors  of  this  Association,  who  are  grumbling 
at  the  loss  of  practice  by  the  druggists  repeat- 
ing their  prescriptions,  not  only  to  their  patients, 
but  to  the   public  generally.     They    seem   to 
think  that  considering    that  they  attend  hun- 
dreds of  people   for  nothing  who  are  too  poor 
to  pay,  they  should  at  least  receive  a  modest  fee 
for  curing  the  young  man  with  gonorrhoea  who 
has  spent  a  hundred  dollars  or  more  in  painting 
the  town  red  and  contracting  his  disease. 


68 


THE   CANADA   MEDICAL   RECORD. 


Every  physician  can  recall  at  least  a  score  of 
cases  in  which  the  patient  has  tried  the  drug 
store  first  before  consulting  the  physician.  In 
justice  to  the  druggists,  it  must  be  said  that  the 
public  tempt  them  to  do  this  thing,  in  some 
cases  the  latter  being  astonished  and  angry 
because  the  druggist  refuses  to  treat  them  or 
repeat  their  prescriptions.  If  ihe  doctor  does 
not  care  to  give  his  own  medicine,  he  might 
arrange  to  send  his  prescriptions  to  tliose  drug- 
gists who  would  bind  themselves  not  to  repeat 
or  give  copies  of  prescriptions.  We  have  no 
doubt  that  some  arrangement  could  be  made 
by  which  the  evil  might  be  overcome  without 
doing  anything  so  absurd  as  applying  to  tlie 
legislature. 

THE  MURPHY  BUTTON. 
About   a    year    ago    Dr.    Lapthorn    Smith 
brought  the  Murphy  button  before   the   notice 
of  the  Medico-Chirurgical  Society  of  Montreal, 
when  its  application  to  end-to-end  and  lateral 
anastomosis    was  demonstrated    on    pigs'   in- 
testines.    The    members   were   favorably    im- 
pressed by  the  rapidity  with  which  the   oper- 
ation was  performed,  as  well  as  by  its  simplicity, 
and  since  then  two  of  the  members,  Drs.  Shep- 
herd and  Jas.  Bell,  have  employed  it  in  several 
cases  with  very  good    results.     Two   of  these 
cases   have   been    seen   by  the  writer  several 
weeks  after  the  operation,  and  they  were  quite 
convalescent,  although  the  button  had  not  then 
passed  per  rectum.    This,  however,  was  a  mat- 
ter of  very  little  consequence,  tlie  button  being 
sure  to  pass  in  time,  although  in  many  cases  it 
requires  several  weeks  to  become  detached.    At 
the  last  meeting  of  the  Medico-Chirurgical  Soci- 
ety, Dr.  James  Bell  reported  three  cases  in  which 
he  had  employed  tliis  ingenious  device,  two  of 
the  cases  making  good  recoveries,  but  the  third 
dying  from  dropping  out  of  the  button  before 
union  had  become  complete.     On  the   whole, 
he  spoke  very  highly  of  the  value  of  the  instru- 
ment.    Means  will  probably  be  found  to  pre- 
vent this  accident  from    recurring,   either   by 
going  farther  into  healthy  bowel  to  avoid  the 
chance   of  anastomozing   intestine  which  has 
lost  its   vitality,  or   by  running    a    silk   suture 
around  the  joined  edges  after  the   button  has 
been  inserted,  so  as  to  hold  the  serotis  edges  to- 
gether, even  if  adhesions  failed  to  form  between 
the  cutting  rings.     During  a    recent   visit  to 


Toronto,  Dr.  Murphy  called  attention  to  a 
number  of  buttons  which  were  being  sold  by 
dealers  which  were  full  of  dangerous  defects. 
We  have  seen  some  of  these  defective  buttons 
in  Montreal  which  were  made  in  England  by  a 
man  who  failed  to  grasp  the  idea  of  the  button, 
for  there  was  no  collar  projecting  around  which 
tlie  intestine  ends  were  to  be  drawn.  Such  a 
button  could  not  be  used  successfully.  It  is 
only  fair  to  an  instrument  or  to  the  man  who 
invents  it  that  the  genuine  article  be  em.ployed, 
and  after  failure  it  is  evidently  unjust  to  con- 
demn his  instrument  or  his  method  when  some 
entirely  different  method  or  instrument  has 
been  used.  The  Murphy  button  has,  we  think, 
come  to  stay,  and  greater  familiarity  with  its 
working  will  probably  render  it  more  and  more 
useful  and  safe. 


THE  ANIT-TOXINE  TREATMENT  OF 
DIPHTHERIA. 
It  is  a  pretty  generally  accepted  fact  that 
people  who  liaye  had  a  zymotic  disease 
rarely  have  it  a  second  time,  and  even  if  they 
do,  the  second  attack  is  much  milder  than  the 
first.  Why  is  this  the  case?  *  Some  change 
has  taken  place  in  the  blood  which  renders  it 
an  unsuitable  soil  for  that  particular  germ. 
Lady  Montague  applied  this  principle  by  in- 
oculating healthy  people  with  smallpox  serum, 
in  order  to  give  them  a  mild  form  of  smallpox 
which  would  protect  them  from  a  second  at- 
tack. Sir  William  Jenner  discovered  that 
smallpox  virus,  after  passing  through  several 
generations  of  cows,  became  much  weakened, 
so  that  inoculation  with  it  was  far  less  danger- 
ous than  with  the  original  virus.  Koch  and 
Pasteur  discovered  that  the  same  law  applied 
to  cholera  and  tuberculosis,  and  although  the 
latter  has  not  proved  so  valuable  as  it  was  at 
first  claimed  for  it,  it  promises  that  at  some 
not  far  distant  time  it  will  yet  fulfill  the  claims 
which  its  inventor  has  made  for  it.  More 
lately,  pupils  of  Koch  and  Pasteur  have  been 
experimenting  with  diphtheria  viru';,  and  have 
made  the  remarkable  discovery  that  by  inoc- 
ulating the  horse  with  diphtheria  bacilli,  and 
thus  giving  it  the  disease,  the  serum  of  that 
horse  has  an  antidotal  effect  upon  the  di{)hthe- 
ria  bacilli  when  the  serum  is  injected  into  the 
infected  patient's  blood.  It  acts  as  an  anti- 
dote, and  is  therefore  called  anti  toxine.     'I'he 


'iHE   CANADA   MEDICAL    RECORD. 


69 


modus  operandi  is  quite  comprehensible  if 
we  take  alcoholic  fermentation  as  an  example. 
A  few  germs  placed  in  a  s^uitable  medium,  say 
grape  sugar  solution,  multiply  by  the  million, 
consuming  the  sugar  and  giving  out  a  poison- 
ous alcohol.  When  a  certain  percentage  of 
this  poison  has  been  produced,  further  fermen- 
tation is  arrested  and  fungi  in  the  solution  die; 
nolonly  this, but  if  some  of  the  toxine — alcohol 
— be  distilled  from  the  solution  and  introduced 
into  another  jar  which  has  been  attacked  by 
fermentation  of  disease,  fei mentation  will  be  im- 
mediately arrested,  and  the  yeast  plant  will  be 
killed.  Alcohol  is  therefore  at  the  same  time 
a  ptomaine  and  an  anti-toxine.  The  new  rem- 
edy is  now  being  tried  on  an  extensive  scale, 
and  we  shall  soon  be  in  a  position  to  know 
what  its  true  value  is.  Its  inventors  claim  that 
it  reduces  the  mortality  down  to  24  per  cent., 
which  does  not  seem  to  be  much  lower  than 
the  treatment  iieretofore  employed.  Some  of 
those  who  are  trying  the  new  remedy  are  ob- 
taining much  better  success  than  its  inventors 
claim,  but  this  can  be  explained  on  the  ground 
of  defective  diagnosis.  Doubtless  many  cases 
of  sore  thioat  will  be  treated  with  anti-toxine, 
and  the  patients  will  recover  ;  but  as  many 
Boards  of  Health  are  offermg  to  make  an  ab- 
solute diagnosis  by  the  culture  process,  this 
source  of  error  should  be  eliminated.  On  the 
whole,  while  the  value  of  anti-toxine  is  probably 
being  overrated,  it  is  apparently  a  step  in  ad- 
vance in  the  great  warfare  of  science.  It  must 
be  distinctly  understood  that  the  treatment  is  in 
the  experimental  stage,  and  as  such  had  better 
for  the  present  be  left  in  the  hands  of  hospital 
physicians,  who  have  at  their  disposal  all  the 
appliances  necessary  to  make  the  experiments 
accurate  and  scientific.  Since  writing  the 
above,  we  have  seen  a  statement  by  Baginsky, 
an  undoubted  authority  in  Berlin,  that  the 
mortality  has  fallen  to  14  per  cent. 


POST    GRADU.Vl'E    INSTRUCTION    IN 
MONTREAL. 

Some  years  ago  we  called  the  attention  of 
our  readers  to  the  immense  opportunities  which 
Montreal  now  offers  for  post-graduate  instruc- 
tion, and  we  suggested  that  a  post-graduate 
course  be  organized.  Our  esteemed  contem- 
porary, the  Montreal  Medical  Journal^  in 
its  last  issue  has  given  the  suggestion  power- 


ful support,  so  that  all  that  is  required  is  the 
organization  of  all  the  teachers  and  hospital 
pliysicians  and  surgeons  into  a  post-graduate 
school.  To  make  it  a  success,  all  the  schools 
and  hospitals  should  join  it,  so  that  the  phy-  ( 
sicians  may  learn  as  much  as  possible  with  the 
smallest  possible  loss  of  time.  From  what  we 
know  of  the  work  going  on  every  day  at  the 
Royal  Victoria,  the  General,  the  Hotel  Dieu, 
the  Notre  Dame,  and  the  Western,  as  well  as 
the  Montreal  Dispensary,  which  though  last  is 
not  least  in  the  value  of  experience  which 
niay  be  gained  there,  a  practitioner  could  fully 
occupy  all  his  time  from  12  till  6.30  p.m. 
every  day  except  Sunday.-  From  8  to  12  he 
could  devote  to  laboratory  work,  or  occasionally 
at  private  operations  by  some  of  the  gynaecolo- 
gists who  generally  operate  from  g  till  12.  We 
trust  that  before  long  we  may  be  able  to  give  an 
affirmative  reply  to  the  many  enquiries  which 
we  receive  asking  whether  there  is  any  post- 
graduate school  in  Montreal. 


THE  CANADIAN  MKDICAL  REVIEW. 
This  is  the  title  of  a  new  medical  journal  to 
be  published  by  the  late  members  of  the  staff 
of  the  Canadian  Medical  Monthly,  headed  by 
our  friend  Dr.  Aitkin.  Although  Canada  is 
fairly  well  supplied  with  journals  already,  we 
are  always  glad  to  extend  a  hearty  welcome  to 
just  one  more.  The  competition  will  lead  to  a 
struggle  for  existence  which,  while  it  will  end 
fatally  for  some  of  them,  will  surely  lead  to  the 
improvement  of  those  wliich  survive. 


THE  CANADIAN  MEDIC  \L  MONTHLY. 

We  are  glad  to  learn  that  although  the  old 
staff  of  editors  of  this  very  creditable  journal 
have  suddenly  left  as  the  result  of  some  seismic 
disturbances  in  the  editorial  sanctum,  the 
monthly  will  continue  to  ai^pear  with  a  new 
staff  headed  by  our  friend  Dr.  B^attie  Nesbitt. 


Drs.  W.  H.  B.  Aitkins,  A.  B.  Atherton,  J. 
Ferguson,  J.  H.  Burns,  A.  A.  Macdonald,  and 
G.  Sterling  Ryerson,  have  severed  their  con- 
nection with  the  Dominion   Medical  Monthly. 


A  GENEROUS  BEQUEST. 
By  the  will  of  the  late   Dr.  Good  ell,  the  cele- 
brated gynecologist  of  Philadelphia,  the  Medi- 


THE    CANADA    MEDICAL    RECORD. 


cal  Department  of  the  University  of  Pennsyl- 
vania has  received  a  bequest  of  $50,000.  Dr. 
Goodell  was  a  man  possessing  the  most  love- 
able  of  characters,  and  one  could  hardly  spend 
an  hour  in  his  society  without  easily  under- 
standing his  popularity.  He  was  an  indefati- 
gable worker,  and  his  world-wide  reputation 
was  slowly  and  gradually  built  up  by  years  of 
hard  work.  A  day  spent  a  few  years  ago  by 
the  writer  in  his  family  circle  will  long  be  re- 
membered for  its  frank  and  genial  hospitality. 


BISHOP'S  COLLEGE. 
We  are  sure  that  many  of  our  readers,  like 
ourselves  and  our  publishers,  have  been  sorry 
to  miss  the  familiar  advertisement  of  Bishop's 
College  from  our  advertising  pages.  We  trust 
that  Its  absence  is  only  temporary,  and  that  by 
next  issue  satisfactory  arrangements  may  be 
made  with  the  publishers  for  its  return  to  its 
accustomed  place.  No  matter  how  hard  may 
be  the  times,  we  believe  that  the  cost  of  the  ad- 
vertisement is  a  good  investment  for  the  Col- 
lege. 


BOOK  NOTICES. 

TraVAUX      d'ELECTROTHERAPIE     GYNEC^^LOGI- 

QUE  ;  Archives  Semestrielles  d'Electrothe- 
rapie  Gynecologique,  fondees  et  publiees 
par  le  Dr.  G.  Apostoli,  vice  i)residenl  de 
laSociete  Frangaise  d'Eiectroiherapie,  etc. 
Paris:  Socie:e  d'Editions  Scientifiques,  4 
rue  Antoine-Dubois,  1894.  Price:  12 
francs.     Post  free. 

This  work,  which  has  just  come  to  hand,  is 
another  evidence  of  Apostoli's  untiring  energy 
and  industry.  It  contains  no  less  than  714 
pages,  in  which  the  experience  with  Apostoli's 
method  of  the  leading  physicians  of  each  coun- 
try is  given  systematically  and  in  detail.  Great 
Britain  lakes  up  254  pages,  and  in  these  appear 
the  opinions,  for  and  against  the  method,  of  the 
two  Keiihs,  Playfair,  Moore,  Madden,  Halliday 
Croom,  Simpson,  Inglis,  Parsons  and  Heywood 
Smith.  Belgian  writers  occupy  10  pages, 
American  writers  80  pages,  Russia  150,  while 
the  remaining  200  pages  are  taken  in  turn  by 
Italian,  German,  Danish,  Austrian,  Polish, 
Hungarian  and  Canadian  writers. 

Apostoli  in  the  introduction  sa\s  that  Elec- 
trotherapeutics has  no  desire  to  pose  as  a  rival 
to  surgery,  which  has  rendered  and  is  still  ren- 
dering every  day  such  marked  and  various  ser- 
vices to  gynaecology;  but  it  wishes  that  its  spe- 
cial utility,  varying  according  to  the  cases,  but 


sometimes  great,  should  be  appreciated  at  its 
just  value  as  a  means  of  curing  symptoms  with- 
out destroying  the  organs.  Electricity  wishes 
to  put  an  end  to  the  unjustifiable  ostracism 
with  which  it  was  treated  from  the  beginning, 
and  which  is  due  to  the  indifference  or  com- 
bined hostility  of  the  medical  profession  born  of 
the  la  tter's  ignorance  of  the  laws  which  govern 
electricity, — ignorance  which  has  been  kept  up 
by  its  interest  in.  treatment  by  operation. 
Apostoli  has  felt  that  the  time  had  come  to 
place  the  experience  of  those  who  have  tried 
it  abroad  within  the  reach  of  French  readers, 
and  he  has  therefore  set  about  the  enormous 
task  of  collecting  the  reports  which  have  ap- 
peared in  books  and  journal  articles  all  over 
the  world,  and  in  many  different  languages, into 
one  series  of  volumes, which  will  appear  at  regu- 
lar intervals  in  the  French  language.  The  first 
volume  is  before  us,  and  the  next  will  shortly 
appear.  Apostoli  himself  in  these  volumes 
contributes  numerous  foot-notes  wherever  he 
finds  that  his  disciples  have  exceeded  their 
master  in  zeal,  or  that  its  enemies  have  ac- 
corded his  method  less  than  the  justice  which 
it  deserves.  In  the  succeeding  volumes,  after 
all  the  foreign  articles  have  been  collected  and 
published,  he  will  bring  out  a  volume  of  arti- 
cles and  rejiorts  of  cases  by  French  physicians, 
including  his  own  very  large  and  rich  experience, 
which  must  now  number  many  .hundreds  of 
cases.  Anyone  who  reads  the  testimony  con- 
tained in  the  volume  before  us  from  well-known 
men  in  all  parts  of  the  world  must  admit  that 
Electricity  in  gynaecology  has  come  to  stay,  and 
that  when  the  present  operative  furore  has 
passed  gynaecologists  will  use  it  much  more  in 
the  future  than  they  have  in  the  past. 

Any  of  our  readers  who  are  acquainted  with 
French  sh  )uld  procure  this  book. 
The  Pocket  Anatomist.     By  C.  Henri  Leon- 
ard, A.M.,  M.D.,    I'rof.  of    Gynaecology, 
Detroit    College    of  Medicine.     Leather, 
300     pages,     193    illustrations,    postpaid 
$1.00.     The  Illustrated    Medical  Journal 
Co.,  Publishers,  Detroit,  Mich. 
The  1 8th  edition  of  this  popular  anatomy  is 
now  before  us;  it  is  printed  upon    thin  paper 
and  bound  in  flexible  leatiier  so  as  to  be  spe- 
cially handy  for  the  pocket.      I'he  illustrations 
are  photo-engraved  from  tiie  English  edition 
of  Gray'.s  Anatomy,  so  are  exact   as  to  their 
details.     Three  large  editions  have  been  sold 
in  England,  testifying  to  its  popularity  there, 
and  some  sixteen    thousand  copies  have  been 
sold  in  this  country.     It  briefly  describes  each 
Artery,  Vein,    Nerve,  Muscle  and    Bone,    be- 
sides the  several  Special   Organs  of  the  body. 
It  contains  more  illustrations  than   any  of  the 
othei;  small  anatomies. 

SvLi.Ar.us  OF  Lectures  on   Human  E.mhrvo- 
LOGY.     \n  introduction  to  the   Study  of 


THE  CANADA  MEDICAL  RECORD. 


71 


Obslelrics  and  Gynaicology.  P'or  Medical 
Students  and  Practitioners.  With  a  Glos- 
sary of  Embryological  Terms.  By  Walter 
Porter  Manton,  M.D.,  Professor  of  Clini- 
cal Gyncecology  and  Lecturer  on  Obstetrics 
in  the  Detroit  College  of  Medicine  ;  Fel- 
low of  the  Royal  Microscopical  Society, 
of  the  British  Zoological  Society,  Ameri- 
can Microscopical  Society,  etc.  Illus- 
trated vvith  seventy  (70)  outHne  draw- 
ings and  photo-engravings.  i2mo. 
cloth,  126  pages,  interleaved  for  adding 
notes  and  other  illustrations,  $1.25  net. 
Philadelphia ;  The  F.  A.  Davis  Co., 
Publishers,  i9i4and  1916  Cherry  Street. 
This  is  a  handy  little  volume,  and  may  help 
to  make  the  student  take  more  interest  in  a 
subject  which  is  generally  sadly  neglec.ed. 

Practical      Urin'Alysis       and       Urinary 
Diagnosis.     A  Manual    for  the     Use    of 
Physicians,  Surgeons,  and  Students.     By 
Charles  W.  Purdy,  M.D.,  Queen's  Univer- 
sity;  Fellow    of  the     Royal    College    ol 
Physicians     and      Surgeons,      Kingston  ; 
Professor   of  Urology  and    Urinary  Diag- 
nosis at  the  Chicago  Post-Graduate  Medi- 
cal School.     Author  of  "  Bright's  Disease 
and  Allied  Affections  of  the    Kidneys  "  ; 
also    of  "  Diabetes  :     Its    Causes,    Symp- 
toms, and   Treatment."      With  numerous 
illustrations,    including    photo-engravings 
and  colored  plates.     In  one  crown  octavo 
volume,    360  pages,  in  extra  cloth,   $2.50 
net.     Philadelphia  :  The  F.  A.  Davis  Co., 
Publishers,  1914  and  1916  Cherry  Street. 
Part  I.  On  analysis  ofurine,  contains  chap- 
ters  on  general  consideration,  theories  of  se- 
cretion and  excretion  of  urine,  composition  of 
normal      urine,  .    abnormal    urine,     proteids, 
carbo-hydratics,  urinary    sediments,    chemical 
sediments,  anatomical    sediments,    gravel  and 
calculus.     Part  2.  Urinary  diagnosis.  Diseases 
of   the  urinary  organs  and    urinary  disorders. 
The  urine  in  other  diseases.     The  book  is   not 
only  very  practical,  but  is  also  very  interesting, 
and  above  all  is  thoroughly  up  to  date. 

Text-Book  of  Hygiene.  A  Comprehensive 
Treatise  on  the  Principles  and  Practice  of 
Preventive  Medicine  from  an  American 
Stand-point.  By  George  H.  Rohe,  M.D., 
Professor  of  Therapeutics,  Hygiene,  and 
Mental  Diseases  in  the  College  of  Physi- 
cians and  Surgeons,  Baltimore  ;  Superin- 
tendent of  the  Maryland  Hospital  for  ihe 
Insane;  Member  of  the  American  Public 
Health  Association  ;  Foreign  Associate  of 
ihe  Society  Fran^aise  d'Hygiene,  etc. 
Third  edition,  thoroughly  revised  and 
largely  rewritten,  with  many  illustra- 
tions and  vah^able  tables.  Royal  oct- 
avo? 553  pages.  Cloth,  $3.00  net. 
Philadelphia :  The  F.  A.  Davis  Co.,  Pub- 
lishers, 1914  and  1916  Cherry  Street. 


This  valuable  boo!<.  has  met  with  well  de- 
served success,  having  already  reached  its 
third  edition.  Every  chapter  has  been  sub- 
jected to  a  careful  revision,  and  the  advances 
in  sanitary  science  and  practice  have  been  in- 
corporated. Dr.  Rohe  is  well  known  as  a 
writer  of  great  clearness,  and  in  this  work  he 
has  kept  up  his  reputation  in  this  respect. 
We  bespeak  for  his  book  a  large  sale  in  Canada. 

A  Famous  Show  ok  Beauty.  The  show  of 
distinguished  beauty,  transfixed  by  famous 
artists,  which  is  now  taking  place  at  the 
Academy  of  Fine  Art>  in  New  York,  has 
been  anticipated  by  the  Cosmopolitan 
Magazine  in  its  November  issue,  in  an 
article  by  Wm.  A,  Coffin,  with  illustrations 
of  some  of  the  more  beautiful  faces.  The 
"Great  Passions  of  History"  series  has 
for  this  month's  subject  the  romantic 
career  of  Agnes  Sorel,  who  influenced 
the  destinies  of  France  under  Charles 
VII.  "  The  Art  Schools  of  America," 
"The  Great  British  Northwest  Territory," 
"The  Chiefs  of  the  American  Press,"  and 
the  "Public  Library  Movement,''  *are 
amongst  The  Cosmopolitan's  table  of 
contents.  Survivors  of  the  war  and  their 
children  will  find  intense  interest  in  "  The 
Story  of  a  Thousand,"  a  personal  narra- 
tive begun  in  this  number,  by  Albion  W. 
Tourgee,  who  tells  in  a  graphic  way  of  a 
regiment  which  saw  fierce  service — of  its 
organization,  its  marches,  its  sports,  and 
its  dealh-roll. 

Saunders'   New   Aid  Series:    A  Manual   of 
Modern     Surgery — General      and    Opera- 
tive.    By  John  Chalmers  Da  Costa,  M.D., 
Demonstrator  of  Surg,  ry,  Jefferson  Medical 
College,  Philadelphia  ;  Chief  Assistant  Sur- 
geon, Jefferson  Medical  College  Hospital, 
etc.,  with  r88  illustrations  in  the  text  and 
13    full-page  plates    in    colors    and   tints, 
aggregating    276  separate    figures.     Phila- 
delphia :     W.    B.  Saunders,    925    Walnut 
Street.     1894.     Price,  $2.50  net. 
The  autlior  states  that  his  aim  has  been  to 
present  in  clear  terms  and  in  concise  form  the 
fundamental  principles,  the  chief  operations  and 
the  accepted  methods  of  modern  surgery,  seek- 
ing   to  stand   beiween  the  com.plete  but  cum- 
brous text-book  and  the  incomplete  but  concen- 
trated   compend.      A  careful    examination    of 
the  work  certainly  proves  his  object  has  been 
well  attained.     There  is  nothing  obsolete  about 
it,    and  there  is  no  padding.      The  first  chap- 
ter  is  devoted   to  Bacteriology,    without  some 
knowledge    of  the    vital     principles    of  which 
branch   of  science  the    vast   importance   of  its 
truths  will  be  ill  appreciated,  and  there  will  be 
inevitable    failure   of    aseptic    and    antiseptic 
methods.    The  paper  and  printing  are  excellent, 
and  students  and  others  who  need  this  excellent 


71 


TllE  CANADA  MEDICAL  RECORD. 


book  are  indebted  to  iheiniblisIiLis  for  keeping 
the  price  at  so  moderate  a  figure  as  two  dollars 
and  a  half.  We  have  no  hesitation  in  saying 
that  this  is  one  of  the  best  manuals  that  have 
appeared  this  year,  and  we  heartily  conyratu 
ate  the  author  upon  his  success. 


PAMPHLETS. 

HvPFRTROrHY        OF       THE      PHARYNGEAL      OR 

Luschka's  ToNSiL.  Read  in  the  Section 
on  Laryngology  and  Otology  at  the  Forty- 
Fifth  Annual  Meeting  of  the  American 
Medical  Association,  JK-ld  at  San  Fran- 
cisco, June  5th  to  8th,  1894.  By  K.  Flet- 
cher Ingals,  A.M.,  M.D.,  Chicago,  111. 
Keprinted  from  the  Journal  of  the  Ameri- 
can Medical  Association,  September  cp. 
1894.  Chicago  :  American  Medical  Asso- 
ciation Pies.  1894. 

A  Calendar  for  1895. — Upon  receipt  of  re- 
quest^ P.  Blakiston,  Son  &  Co.,  medical 
booksellers,  1012  Walnut  Street,  Philadel- 
phia, wi'l  send  free  by  mail,  postage  pre- 
paid, a  neat  desk  Calendar  for  1895. 

A  Case  (  f  Chronic  Peritonitis,  with  In- 
testinal AND  Abdominal  Fistul.« — 
Entergrrhaphy — Recovery.  By  Fre- 
derick Holme  Wiggin,  M.D.,  President 
of  the  Society  of  Alumni  of  Bellevue  Hos- 
pital ;  Visiting  Surgeon  to  the  City  Hospi- 
tal, Gynaecological  division. 

New  Instruments.  Read  in  the  Section  on 
Laryngology  and  Otology,  at  the  Forty- 
Fifth  Annual  Meeting  of  the  American 
Medical  Association,  held  at  San  Fran- 
cisco, June  5-8,  1894.  By  Seth  Scott 
Bishop,  M.D,,  Professor  of  Otology  in 
the  Post-Graduate  Medical  School  and 
Hospital,  Chicago,  111.  Reprinted  from 
the  Journal  of  the  American  Medical 
Association,  September  29,  1894.  Chi- 
cago: American  Medical  Association 
Press,  1894. 

Societe  d'^ditions  Scientifiques.  Place 
,  de  I'Ecole  de  Medecine,  4  rue  Antoine- 
Dubois,.  Paris.  Precis  Iconographique 
d'Anatomie  Normale  de  I'CEil.  Globe 
Oculaire  et  Nerf  Optique,  par  le  Docteur 
Rochon-Duvigneaud,  ancicn  Interne  des 
Hopitaux;  ancien  Chef  du  Laboratoire 
d'Ophihalmolog;eaL'H6tel-Dieu  ;  Chefde 
Cliniquc  Ophthalmologique  de  la  Faculte. 
In-Pvo  raisin  de  136  pages,  23  figures. 
Prix:  s  fr.  broche  ;  6  fr.  cartonne  a  I'an- 
glaise  \  7  fr.  50  reliure  souplc,  peau  pleine, 
cuir  vert. 

La  Lepre. — Obseivations  et  experiences  per- 
sonncUcs.  Par  le  Docteur  Jules  Gold- 
schmidt.  Paris:  Societe  d  Editions  Scien- 


tifiques, Place  de  I'EcoIe  de  Medecine,   4 
rue  Antoine-Dubois.     1894. 

Persistent  Albuminuria  and  Glycosuria, 
WITH  frequent  Hyaline  Casts,  in 
Functional  Nervous  Diseases.  By 
Landon  Carter  Gray,  M.D.,  of  New 
York.  From  the  American  Journal  of  the 
Medical  Sciences.     October,   1894. 


PUBLISHERS  DEPARTMENT. 

Literary    Notes    from    The    Ladies'    Home 
Journal.,  Philadelphia. 

When  his  present  American  visit  is  con- 
cluded, Conan  Doyle  will  write  an  article  for 
The  Ladies'  Home  Journal  on  American 
women,  telling  "  How  Your  Women  Impressed 
Me." 

Mrs,  Burton  Harrison  is  writing  a  sen'es  of 
articles  for  and  about  society  girls,  which  The 
Ladies'  Home  Journal  will  begin  in  one  of  its 
early  issues. 

The  quaint  little  women  of  Kate  Greenaway 
are  to  be  seen  in  a  magazine  for  the  first  time 
since  their  creation.  Miss  Greenaway  has 
heretofore  always  drawn  them  in  color  and  for 
book  publication.  Now,  however,  she  is  at 
work  upon  a  special  series  of  her  curious  tots 
for  The  Ladies'  Home  Journal,  and  in  that 
periodical  they  will  alternate  with  a  new  series 
of  Palnier  Cox's  funny  "  Brownies." 


LITTELL'S  LIVING  AGE  FOR  1895. 

The  success  of  this  sterling  periodical  is  owing  to  the 
fact  that  it  enables  one,  with  a  small  outlay  of  lime  and 
money,  to  keep  pace  with  the  best  thought  an  1  literature 
of  the  day.  Hence  its  importance  to  every  American 
reader. 

It  has  always  stood  at  the  head  of  its  class,  both  in  the 
quality  and  quantity  of  the  reading  furnished  ;  and  in  fact 
it  affords,  of  itself,  so  thorough  and  compleie  a  coiupen- 
dium.of  what  is  of  immediate  interest  or  permanent  value 
in  the  literary  world  as  to  render  it  an  invaluable  econo- 
mizer of  time,  labor  and  money.  In  the  multitude  of 
periodicals  of  the  present  time, — quarterlies,  monthlies 
and  weeklies,  — such  a  publication  has  become  almost  a 
necessity  to  every  person  or  family  desiring  to  keep  well 
informed  in  the  best  literature  of  the  day. 

For  1895.  an  exlraordin:iry  offer  is  made  to  all  new  sub- 
scribers ;  and  reduced  clubb  ng  rales  with  other  p  r.udicals 
are  also  given  by  which  a  subscriber  may  at  remarkably 
small  cost  obtam  the  cream  of  both  home  and  foreign  lite- 
rature. Tliose  selecting  their  pciiodicals  for  the  new  year, 
would  do  well  to  examine  the  pro  pectus.  In  no  other 
way  th.it  we  know  of  can  a  subscriber  lie  put  in  posses- 
sion of  the  best  which  the  current  litterature  of  the  world 
affords,  s  >  cheaply  or  conveniently. 

Littell  •Sr'  Co.,  Boston,  are  the  publishers. 


■tifeil  I 


Vol.  XXni. 


MONTREAL,  JANUARY,  1895. 


ORIGINAL  COMMUNICATIONS. 

Some  obstetrical  Notes 7:) 


SOCIETY  PROCEEDINGS. 

.Monti'ral    .Medico-Chirurgic.'il    Soci- 
ety   7G 

Fracture  of  the  Skull  with  Pulsating 

Tumor 76 

Tubo-Ovariau  Pregnancy     ....  77 

Ovarian  Cyst        '. 77 

Uterus  Bicornis 77 

l>ouble  Pyosaljiinx 77 

An  Iiitra-ocular  Tumor-Scopalamine 

a.s  a  Mydriatic  78 

The  Pulse   and  Kespiration  during 
Ether    Aiuesthesia  with    Clover's 

Inhaler 78 

A  Case  of  Goring  bv  Ox  with  Wound 

of  Bowel 81 

A  Case  of  Medico-I.egal  Interest 8'2 

Polydactylas 82 

Excision  of  ^faxilla  82 


oo:tTTEisra?s. 

il.iternal  Impressions— ^lissed  Abor- 
tion— Monstrosity  (.Tanieeps) Sj 

Paralysis  in  Chihlreu  8.'3 


PROGRESS  OF  SCIENCE. 


.Morton, 


Sll 


91 


William     'I'liomus     Gi 

M.I) 

The  Treatment  of  Gonoi-rha>a  by  Ir- 
rigation of  the  Urethra.. ,  . . , 

The  Treatment  of  Diabetes  Mellitiis 
The  New  Cure  for  I)iphther.a,Croup 

etc  

Treatment  of  Kenal  Disease  92 

Sonic  New  Animal  Extracts <)s 


EDITORIAL. 

Removal  of  the  Uterus  by  Enuclea- 
tion without  Clamp  or  Ligature.. . 


Book  Kevicws 94 


BOOK  NOTICES. 

The  Index  Medicus 94 

Cazeaiix  and  Tarnier  95 

A  Text-Book  of  Pathology 9.5 

Notes  on  the  Newer  Remedies 95 

Physiology  for  Beginners 95 

Syllabus  of  Gyna-cology  95 

Laboratory  good  for  the   Bacterio- 
logist   i)t; 


Pamphlets  received ;)0 


Publishers'  Department . 


Prigfnal    ^Communications. 

SOME    OBSTETRICAL    NOTES. 

By  a.  Lapthorn  Smith,  M.D.,  M.R. 
C.S.  Eng.,  GyncEcologist  of  the  Mont- 
feal  Dispensary,  Surgeon  to  the  West- 
ern Hospital,  Felloiv  of  the  American 
Gynaeologieal  Society. 

During  the  last  20  years  some  interest- 
ing cases  of  midwifery  have  come  under 
my  notice,  some  of  which  I  have  never 
yet  reported,  and  which  may  prove  of  in- 
terest to  the  busy  practitioner,  who  is  most 
likely  to  meet  with  similar  ones.  The 
following  two  cases  of  hydrocephalus 
were  puzzling, — the  first  one  to  myself, 
occurring  as  it  did  in  the  beginning  of  my 
practice  ;  and  the  second  to  the  family  phy- 
sician in  connection  with  whom  I  was 
called  to  see  the  case. 

Case  I  was  a  multipara  of  some  30 
years  of  age,  who  sent  for  me  to  attend  her 
in  her  confinement.  In  due  time  the  os 
became    fully    dilated,  the   bag  of  waters 


broke,  but  the  head  did  not  engage  in  the 
pelvis. 

On  careful  examination  the  pelvis  was 
found  to  be  of  normal  size,  but  the  child's 
head  seemed  very  large.  After  waiting 
several  hours,  labor  going  on  furiously  and 
no  progress  being  made,  I  decided  to 
apply  my  long  Baudeloque  forceps,  the 
only  one  I  ever  use,  and  the  best  forceps, 
in  my  opinion,  that  have  ever  been  made, 
and  made  prolonged  and  forcible  efforts 
at  delivery,  but  Avas  unable  to  make  the 
head  descend.  I  went  in  search  of  my 
friend  Dr.  Kennedy,  who  also  tried  to 
deliver  with  forceps,  but  with  no  better 
success.  He  then  introduced  his  hand 
above  the  brim  of  the  pelvis,  and  perceived 
that  it  was  a  case  of  hydrocephalus,  when 
he  quickly  punctured  the  fontanelle,  and 
allowed  what  appeared  to  be  an  enormous 
quantity  of  water  to  escape,  when  the  head 
quickly  descended,  and  the  child  was  born 
within  a  few  minutes,  but  of  course  dead. 

In  this  case  the  force  used  in  our  ineffec- 
tual efforts  at  delivery  with  the  forceps 
had  considerably  bruised  the  cellular  tissue 


74 


THE   CANADA   MEDICAL   RECORD. 


surrounding  the  uterus  about  the  brim  of 
the  pelvis,  with  the  result  that  the  woman 
had  a  genuine  pelvic  cellulitis,  or,  perhaps 
more  properly,  a  necrosis  of  the  cellular 
tissue  ;  an  abscess  formed  and  pointed  at 
Poupart's  ligament,  where  it  was  evacuated, 
and  she  made  a  rapid  recovery. 

Case  II. — I  was  called  early  one  morn- 
ing a  few  months  ago  to  go  in  consultation 
with  the  family  doctor  at  a  small  town  5 
or  6  miles  from  Montreal.  On  arriving  at 
the  house,  I  found  the  attendant  worn  out 
with  all  night  attendance,  when  he  in- 
formed me  that  he  had  been  called  in  the 
afternoon  of  the  day  before,  and  found  the 
patient  in  active  labor.  She  was  in  great 
pain,  and  screamed  most  of  the  night;  but 
for  some  reason  he  could  not  explain,  the 
labor  had  made  no  progress,  and  thought 
that  this  was  due  to  its  being  a  breech 
presentation,  as  he  could  feel  no  bones  of 
the  head,  and  on  the  contrary  he  felt  a 
slight  dent  in  the  centre  of  a  soft  mass 
which  he  thought  must  be  the  anus.  On 
examination,  however,  although  this  dent 
was  somewhat  misleading,  I  had  no  diffi- 
culty in  diagnosing  a  case  of  hydroce- 
phalus, and  by  manual  palpation,  I  ascer- 
tained that  the  child's  head  was  of  enor- 
mous dimensions.  The  mother  informed 
me  that  she  had  thought  all  along  that 
she  had  twins,  as  she  had  never  been  so 
large  before. 

I  placed  her  under  an  anaesthetic,  and  in- 
troduced my  hand  under  careful  aseptic 
precautions  above  the  pelvic  brim,  when, 
*  as  far  as  I  could  reach,  nothing  could  be 
felt  but  the  enormous  head.  The  bones  of 
the  skull  were  more  like  parchment,  and 
could  be  easily  indented  with  a  sort  of 
crackling  feeling.  As  there  was  no  object 
in  submitting  the  mother  to  any  risk  for 
the  problematical  advantage  of  saving  a 
child  with  this  disease,  and,  moreover,  as 
the  mother  believed  the  child  was  dead,  I 
punctured  the  fontanelle  with  a  pair  of  > 
sharp-pointed   scissors,  which    I  had  disin- 


fected for  the  purpose,  and  allowed  what  I 
should  estimate  to  be  between  2  and  3 
quarts  of  clear  hydrocephalic  fluid  to 
escape. 

By  introducing,my  finger  into  the  hole 
thus  made,  I  was  able  to  get  a  hold  of  one 
of  the  parietal  bones,  which,  however,  dou- 
bled up  under  the  pressure,  but,  neverthe- 
less, giving  me  a  sufficient  hold  to  draw 
down  the  head,  and  quickly  deliver  the 
child.     The  mother  made  a  rapid  recovery. 

These  are  the  only  cases  of  hydroce- 
phalus that  I  have  met  with  in  about  800 
confinements. 

Case  III.  I  was  called  early  one  morn- 
ing to  see  a  woman  whom  I  had  confined  of 
her  first  child  a  few  years  before,  and  found 
that  she  had  been  in  labor  for  more  than 
24  hours.  For  financial  reasons  she  had 
not  engaged  me  for  this  con.finement,  but 
had  taken,  instead,  a  midwife.  She  was 
evidently  very  poor,  the  house  being  ex- 
ceedingly dirty,  while  her  bed  was  simply 
filthy.  The  midwife  told  me  that  every- 
thing appeared  all  right  until  the  waters 
broke  about  10  o'clock  the  night  before, 
when  a  hand  of  the  child  presented  and 
appeared  at  the  vulva.  She  became 
alarmed,  and  sent  for  a  neighboring  physi- 
cian, who  was  too  discouraged  with  the 
surroundings  to  attempt  to  do  anything 
for  her  relief,  and  therefore  ordered  her  to 
the  lying-in  hospital.  Having  the  usual 
dislike  for  hospitals  so  common  among  the 
poor,  she  did  not  follow  his  advice.  About 
I  or  2  o'clock  in  the  morning,  as  the 
pains  were  most  violent,  she  sent  for  an- 
other physician,  who  gave  her  the  same  ad- 
vice as  the  first  one,  and  even  paid  for  a 
cab  to  take  her  to  the  hospital.  fi 

On  my  arrival,  about  4  or  5  o'clock,  not 
knowing  that  an}-  other  physician  had  seen 
her,  I  found  the  hand  protruding  from  the 
vulva,  and  the  child  placed  transverse))- 
across  the  abdomen.  I  fortunately  obtain- 
ed a  clean  tin  pan  and  a  kettle  of  hot 
water,  and  with  this  and  ihcaid  ofa  douchr 


THE   CANADA   MEDICAL   RECORD. 


75 


bag  and  some  bi-chloride  tablets,  which  I 
had  with  me,  I  was  able  to  give  her  a  i  in 
2,000  sublimate  douche,  and  also  to  thor- 
oughly disinfect  my  own  hands.  I  ordered 
the  midwife  to  place  her  under  my  A.  C.  E. 
mixture  which  I  had  with  me,  and  in  a  few 
minutes  had  her  sound  asleep,  with  the 
womb  and  abdominal  muscles  thoroughly 
relaxed  ;  it  was  only  the  work  of  a  moment 
to  introduce  one  hand  into  the  uterus,  push 
up  the  shoulder,  aided  by  my  left  hand  on 
the  abdomen,  and  to  seize  the  feet  with 
my  right  hand.  There  was  some  little 
difficulty  in  getting  the  head  through  the 
pelvis,  which  was  rather  a  flat  one,  necessi- 
tating the  high  forceps  application  at  her 
first  confinement.  I  was  obliged  to  apply 
the  forceps  to  the  aftercoming  head.  ThiS) 
however,  was  only  the  work  of  a  few  min- 
utes. Within  fifteen  minutes  of  my  arrival 
at  the  house  the  child  was  born,  but  dead. 
As  I  feared,  hemorrhage,  owing  to  atony 
of  the  uterus  from  exhaustion,  I  adminis- 
tered a  drachm  of  fluid  extract  of  ergot 
before  removing  the  placenta,  and  waited 
about  10  minutes  to  give  this  time  to  take 
effect.  The  placenta  was  then  easily  ex- 
pressed from  the  uterus,  and  the  latter  or- 
gan held  firmly  in  the  hand  until  all  danger 
of  post-partum  hemorrhage  had  passed. 
The  precaution  was  not  unnecessary,  for 
several  times  I  felt  the  uterus  relaxing  un- 
der my  grasp,  and  at  the  same  time  filling 
up  with  arterial  blood  which  was  expelled 
at  the  next  uterine  contraction. 

After  waiting  until  she  had  thoroughly 
awakened  from  the  anjesthetic  and  all  dan- 
ger of  hemorrhage  was  over,  I  left  her,  with 
strict  injunctions  to  have  her  cleaned  up, 
which  the  midwife  did  as  well  as  she  could 
with  the  means  at  her  command. 

Strange  to  say,  this  patient  recovered  as 
if  there  had  been  nothing  unusual, — thanks, 
I  presume,  to  the  antiseptic  precautions  I 
had  taken. 

Case  IV.  This  patient  engaged  me  a 
couple  of  months  ago  to  confine  her,  tell- 


ing me  that  she  lived  several  miles  away 
from  my  residence,  and  that  she  had  come 
so  far  to  me  in  the  hopes  that  I  could  suc- 
ceed in  delivering  her  of  a  living  child,  as 
she  had  already  been  confined  twice,  but 
each  time  the  baby  had  to  be  destroyed 
in  order  to  be  delivered.  She  was  very 
anxious  to  have  a  living  child,  but  had 
been  thoroughly  discouraged  by  the  three 
very  able  physicians  who  had  told  her  that 
this  was  impossible.  In  fact,  in  a  moment 
of  discouragement,  her  husband  had  thrown 
a  large  stock  of  baby  clothing  into  the 
fire. 

On  examination  I  found  the  pelvis  con- 
tracted, the  antero-posterior  diameter  be- 
ing about  3  inches,  I  advised  her  to  cut 
down  her  diet  to  the  very  smallest  limit 
possible,  in  order  that  the  size  of  the  child 
might  be  kept  down  accordingly.  This 
she  faithfully  did  ;  in  addition  to  which, 
her  husband  aided  me  by  keeping  her 
working  more  than  usually  hard,  and  I 
requested  her  to  drive  at  once  to  my  pri- 
vate hospital  as  soon  as  labor  began,  in- 
tending to  perform  symphysiotomy,  for 
which  I  made  due  preparation.  She  ap- 
peared at  my  private  hospital  accordingly 
at  4  o'clock  in  the  morning  about  lo  days 
ago,  when  I  found  labor  going  on  actively, 
but  the  amniotic  'membrane  unruptured. 
I  carefully  avoided  rupturing  this,  and  left 
her  in  the  charge  of  a  nurse,  with  orders 
to  give  her  just  enough  of  the  A.  C.  E.  mix- 
ture to  keep  her  easy  without  rendering 
her  unconscious. 

My  object  in  doing  this  was  to  give 
nature  a  chance  to  mould  the  child's  head 
to  the  pelvis,  with  the  possible  hope  that 
an  operation  might  be  avoided,  and  that 
the  forceps  applied  high  might  effect  deliv- 
ery instead. 

At  9  o'clock,  after  giving  her  a  bichlo- 
ride douche,  followed  by  a  hot  water  one, 
I  applied  the  long  Baudeloque  forceps  to 
the  head,  which  was  resting  on  the  pelvic 
brim,  but  not  engaged  ;  and  had  the  great 


76 


THE   CANADA   MEDICAL   RECORD. 


satisfaction  of  engaging  the  head  and  gra- 
dually sweeping  it  down  through  the  pelvis, 
as  I  raised  the  handles.  As  the  head 
passed  the  promontory  of  the  sacrum,  I 
heard  a  crackHng  noise,  and  felt  something 
o-ive  way  ;  after  which  the  head  was 
easily  delivered. 

On  examination  afterwards,  this  proved 
to  be  the  left  half  of  the  frontal  bone 
which  had  been  indented  by  the  promon- 
tory of  the  sacrum.  The  right  temporal 
bone  was  very  much  indented  by  the  blade 
of  the  forceps,  and  I  felt  certain  that  the 
child  would  be  injured  by  the  pressure  to 
which  it  had  been  subjected  ;  but,  to  my 
astonishment,  it  seemed  none  the  worse, 
and,  within  a  few  days,  all  marks  of  the 
forceps  and  of  the  indentation  of  the 
frontal  bone  had  disappeared.  This  case 
illustrates  what  we  can  do  in  moderately 
contracted  pelvis,  by  controlling  the  size 
of  the  child,  giving  plenty  of  time  for 
labor  to  do  its  work,  and  the  careful  em- 
ployment of  a  good  long  forceps  applied 
to  the  transverse  diameter  of  the  pelvis. 
Case  V.  was  a  case  somewhat  similar  to 
the  above,  -but  I  did  not  see  the  woman 
until  she  sent  for  me  to  confine  her. 

Labor  had  hardly  begun  when  I  was 
called.  As  it  was  her  first  child,  1  followed 
the  rule  which  I  adopted  since  the  begin- 
ning of  my  practice,  of  allowing  24  hours 
to  elapse  before  terminating  the  first  con- 
finement. By  this  time  the  child's  head 
had  engaged  in  the  superior  strait,  but 
made  no  progress  whatever  during  the 
Idst  3  or  4  hours,  so  that  I  decided  to 
apply  the  forceps  and  terminate  the  labor. 
I  was  sorry  on  extracting  the  head  to  see 
about  a  tablespoonful  of  brains  oozing  out 
of  a  hole  at  the  front  of  the  left  parietal  bone, 
caused  by  the  pressure  of  the  forceps. 

I  gave  a  very  guarded  prognosis, 
although  the  child  was  a  very  large  and 
most  vigorous  one.  To  my  surprise,  he 
seemed  very  little  the  worse  for  this  very 
severe  injury,  and   when   last  seen — now 


some  years  ago — was  about  a  year  old  and 
had  a  naevus  at  this  spot,  about  the  size 
of  a  quarter  of  a  dollar,  which  I  ordered 
the  mother  to  keep  bandaged  ;  since  when 
neither  mother  nor  child  have  been  seen. 
250  Bishop  street. 


MONTREAL  MEDICO-CHIRURGICAL 
SOCIETY. 

Stated  Meeting,   October  i()t/i,  1894. 

G.  P.  GiRDwooD,  M.l).,  President,   in   the 

Chair. 

Drs.  Elzear  Pelletier,  F.  J.    Hackett,  C.    F. 

Wylde,  H.  Tatley  and  W.  E.  Decks  were  elected 

ordinary  members. 

Fracture  of  the  Skull  with  Pulsating 
Tumor. — Dr.  Shepherd  showed  a  little  girl 
nine  years  old,  who  in  1889  had  been  under 
his  care  al  the  Montreal  General  Hospital. 
The  following  is  a  brief  account  of  the  case  : 

Florence  C.,  age  four  years,  admitted  Sep- 
tember 9,  1889.  Ambulance  case.  Fell  from 
second  story  window  on  to  stone  pavement. 
Picked  up  unconscious,  and  continued  motion- 
less for  half  an  hour.  Condition  on  entry, 
unconscious,  pupils  unequal,  swelling  over  the 
right  orbit  with  a  semi-fluctuating  feel,  purpose- 
less movements  of  the  limbs,  Cheyne-Stokes 
respiration.  Her  whole  forehead  and  eyelids 
were  greatly  swollen,  and  at  12  p.m.  that  night 
her  temperature  rose  to  103°.  Three  days  later 
she  seemed  to  be  conscious,  but  she  was  unable 
to  open  her  eyes  from  cedema.  Eight  days 
after  her  admission  she  spoke,  asking  for  food  ; 
her  condition  then  was  slowly  improving.  She 
had  then  a  fluctuating  swelling  over  the  right 
eye  which  pulsated,  and  running  upwards  and 
backwards  from  this  was  a  fissure.  Over  the 
right  parietal  bone  there  was  another  fluctuating 
swelling,  large  and  flat,  but  not  continuous  with 
the  one  in  front.  The  fissure,  however,  ran 
into  it.  The  liole  over  the  orbit  is  still  present, 
and  one  can  feel  the  pulsation  of  the  mem- 
branes through  it.  The  line  of  fracture  running 
up  from  this,  corresponding  to  the  fissure  men- 
tioned above,  can  still  be  made  out  with  the 
finger.  The  swelling  over  the  parietal  bone 
has  disappeared.  The  child's  intelligence  has 
not  been  good  ;  lier  mother  thinks  her  different 
from  other  children  and  not  bright. 

Dr.  Gordon  Camtheli.  remembered  the  case 
very  well,  esi)ecially  so  as  he  had  given  an 
absolutely  bad  prognosis  after  examining  her 
condition  on  entry. 

Dr.  Kinomorn,  House  Surgeon  for  Dr. 
Alloway,  read  the  following  reports  : — 


THE  CANADA  MEDICAL  RECORD. 


77 


1.  lubo-ovarian  rrcgnancy. — Patient,  aged 
31,  complained  of  metrorrhagia,  dysmenorrlicea, 
];ain  in  the  lower  i)art  of  the  abdomen  and  pain 
in  the  back.  Menses  commenced  at  13  years, 
and  continued  normal  till  2'-  years  ago,  when 
her  last  child  was  born.  Since  then  the  above 
symptoms  have  gradually  developed.  Exam- 
ination revealed  lacerated  cervix,  leucorrhcea, 
anteversion  and  a  mass  in  the  posterior  fornix. 
Cceliotomy  recommended  and  performed. 
Upon  opening  the  abdomen,  a  mass  about  the 
size  of  an  orange  was  observed  lying  in  the  left 
half  of  the  pelvis  and  behind  the  uterus.  The 
mass  was  united  by  strong  adhesions  to  the  i)os- 
terior  wall  of  the  pelvis,  to  the  left  broad  liga- 
ment, to  the  whole  extent  of  the  rectum,  and  to 
the  posterior  face  of  the  uterus.  The  adhesions 
were  separated  with  difficulty  by  the  finger,  but 
not  before  the  mass  had  been  ruptured  and 
dark  colored  clotted  blood  escaped.  There 
was  very  little  bleeding,  and  none  of  the  neigh- 
boring viscera  were  injured.  The  pedicle  of 
remains  of  tube  and  ovary  of  left  side  was  tied 
off  in  the  usual  way.  The  abdomen  was  washed 
out  with  boiled  water  and  wound  closed  with- 
out drainage.  It  is  now  the  tifth  day  since  the 
operation,  and  the  patient  has  been  doing  per- 
fectly well. 

Dr.  Alloway,  commenting  on  the  specimen, 
remarked  that  after  removing  the  mass  he 
noticed  it  embraced  within  its  limits  the  ovary 
and  the  fimbriae  of  the  left  tube,  and  the 
thought  occurred  to  him  that  its  situation  sug- 
gested a  tubo-ovarian  pregnancy.  'J'he  sac, 
which  was  really  a  distended  ovary  and  conti- 
guous portion  of  the  tube,  was  fillecl  with  blood, 
etc.,  a  condition  not  unusuil  in  extra-uterine 
pregnancies.  The  specimen  was  submitted  to 
Dr.  Wyatt  Johnson  for  microscopical  examina- 
tion, and  his  report  confirms  this  view.  Thick- 
ened and  altered  chorionic  villi  were  found  in 
that  portion  of  the  mass  which  corresponded 
to  the  dilated  end  of  the  left  tube  ;  no  signs  of 
a  foetus  were  detected. 

2.  Ovarian  Cyst  {^Marsupialization  Method 
Adopted). — Patient  complained  of  pain  over 
sacrum,  in  the  left  groin  and  hip,  painful  mictu- 
rition, dysmenorrhoea  and  sterility.  Menses 
commenced  at  14  years,  married  at  19  years; 
no  children,  no  miscarriages ;  irregular  and 
painful  menstruation,  especially  marked  during 
the  past  two  years.  Examination  revealed  ten- 
derness in  both  iliac  regions,  more  marked  in 
the  right  ;  tenderness  extending  down  the  right 
leg  to  knee-joint.  Anteversion  of  uterus,  being 
firmly  fixed  behind  the  pubic  bone ;  a  large  semi- 
pultaceous  mass  occupied  the  left  pelvis,  pro- 
jecting into  Douglas'  pouch  of  that  side  and 
firmly  fixed  to  the  uterus  in  front.  Cceliotomy 
recommended  and  performed.  On  opening  the 
abdomen  the  omentum  was  found  to  be  adhe- 
rent to  a  mass  beneath  it.  The  mass  proved 
to   be  a  large  cyst  containing  clear   fluid,  and 


grew  from  the  vicinity  of  the  right  ovary.  It 
was  connected  with  nearly  all  the  abdominal 
viscera  by  adhesions  so  dense  that  the  attempt 
to  separate  them  had  to  be  given  up.  From 
this  large  cyst  sprang  a  number  of  daughter 
cysts.  There  was  nothing  left  to  do  but  drain 
off  the  cyst  contents.  Their  cavities  were  con- 
verted into  one  main  cyst,  then  washed  out 
with  boiled  water  and  the  wall  of  the  cyst  sutured 
to  the  peritoneum.  The  cavity  of  the  cyst  then 
opened  into  the  wound,  and  thus  constituted  a 
condition  somewhat  similar  to  that  found  in 
the  marsupialia.  After  thoroughly  drying  the 
cyst  walls  with  sterilized  gauze,  its  cavity  was 
packed  with  iodoform  gauze,  which  acted  as  a 
drain.  Every  other  day  the  iodoform  gauze 
was  changed.  On  the  20th  day  this  was  dis- 
continued and  the  opening  allowed  to  close. 

3.  Uterus  Bicornis. — This  condition  was  met 
with  accidentally  in  the  course  of  an  abdorninal 
section  for  removal  of  the  appendages.  Upon 
opening  the  abdomen  the  uterus  was  seen  to 
consist  of  two  corpora  with  only  one  cervix, 
the  bodies  being  separated  from  each  other  by 
a  well-marked  sulcus.  The  right  one  was  larger 
than  the  left. 

Dr.  Alloway  showed  a  wax  model  of  the  con- 
dition, which  he  said  resembled  very  closely  the 
pelvic  organs  as  they  appeared  in  situ.  His. 
object  in  operating  was  only  to  remove  the  ap- 
pendages, and  the  condition  was  thus  noticed.. 
Bicornate  uteri,  he  thought,  though  heretofore 
regarded  as  very  uncommon,  would  in  the 
future  be  more  often  met  with,  owing  to  the  in- 
creased frequency  of  abdominal  sections.  This 
condition  was  due  to  the  non-fusion  of  that  part 
of  the  MuUerian  ducts  which  go  to  form  the 
body  of  the  uterus, 

4.  Double  Pyosalpinx. — Patient  complained 
of  menorrhagici,  weakness,  dyspareunia,  pains  in 
the  back  and  lower  part  of  the  abdomen  and 
left  leg.  Menses  commenced  at  16  years,  she 
was  married  at  27  years,  had  one  child  and  one 
miscarriage.  The  pain  in  the  back  and  dys- 
pareunia had  existed  for  the  past  three  (3)  years. 
Examination  revealed  uterus  retro  verted  and 
bound  down  by  adhesions,  which  inclined  it 
somewhat  towards  the  right  side.  Removal  of 
the  appendages  was  recommended  and  per- 
formed. On  opening  the  abdomen  the  right 
fallopian  tube  resembled  a  small  sausage,  the 
fimbriated  extremity  had  closed  in,  giving  the 
appearance  of  an  inverted  cone ;  the  ovary  was 
embedded  in  the  tube  which  was  attached  by 
strong  adhesions  to  the  intestines.  The  left 
ovary  was  united  by  dense  adhesions  to  the 
fimbriated  extremity  of  the  corresponding  tube, 
which  bore  a  close  resemblance  in  appearance 
to  the  right,  and  was  also  attached  by  adhe- 
sions to  the  sigmoid  flexure.  The  left  ovary 
proved  to  be  transformed  into  a  large  blood 
cyst.  The  uterus  was  so  firmly  bound  to  the 
sacrum  by  adhesions,  that  these  had  to  be  liga- 


78 


THE   CANADA   MEDICAL   RECORD. 


tured  and  cut  before  it  could  be  released.  It 
was  then  attached  to  the  anterior  abdominal 
wall.     Both  ovaries  and  tubes  were  removed. 

Dr.  Alloway,  commenting  on  the  specimen, 
said  it  was  chiefly  of  interest  as  showing  so 
clearly  the  cause  and  manner  of  the  collection 
of  fluid  in  a  tube,  as  was  the  condition  here, 
the  initial  point  being  the  cementing  of  the  ab- 
dominal end  of  the  tube  by  a  process  of  inver- 
sion of  the  fimbriiTi.  This  inversion  and  cement- 
■'ng  was  most  beautifully  demonstrated  in  the 
present  specimen,  and  he  had  never  seen  one 
where  this  pathological  truth  was  so  perfectly 
exiiibited. 

Dr.  Adanii  had  found  bacilli  in  the  specimens 
submitted  to  him,  but  not  tubercle  bacilli. 
They  were  both  shorter  and  more  stubby  than 
the  latter.  The  condition  was  purely  one  of 
chronic  inflammation,  but  it  showed  that  curi- 
ous proliferation  of  the  lining  mt  mbranes  of  the 
tubes  (forming  various  folds,  and  a  fusion  of 
these  folds  so  as  to  look  like  a  cancerous  con- 
dition), which  is  the  result  of  long  standing 
chronic  congestion  and  consequent  overgrowth 
of  the  parts. 

An  Inira-ocular  Tumor— Scop alavime  as  a 
Mydriatic— Dr.  Buj.ler  presented  an  ordin- 
ary intra -ocular  sarcoma  growing  from  the  cho- 
roid, pigmented  as  usual,  and  nearly  filling  the 
scleral  cavity.  So  far  as  the  growth  itself  was 
conceined,  he  did  not  know  that  it  presented 
any  points  of  special  interest,  but  merely  brought 
it  to  notice  as  an  illustration  of  the  diagnostic 
difficulties  which  these  intra  ocular  growths 
sometimes  offered,  difiiculties  which  are  rather 
augmented  than  diminished  by  the  patient's 
version  of  his  troubles.  The  eye  was  removed 
a  few  days  before  from  an  old  man  of  75 
years,  who  stated  positively  that  he  had  never 
found  anything  wrong  with  the  eye  until  about 
the  middle  of  last  April,  when  he  suffered  a 
slight  injury  from  a  piece  of  brushwood.  After 
this  the  eye  was  sore  for  a  few  days,  but 
apparently  recovered  perfectly.  Some  three  or 
four  weeks  later  he  noticed  it  had  become 
blind.  The  blindness  continued  without  pain 
or  inconvenience  till  about  four  weeks  ago, 
.when  without  assignable  cause  the  eye  became 
inflamed  and  intensely  painful.  The  pain  w:»s 
that  of  a  periorbital  neuralgia,  as  well  as  in  the 
eyeb^l,  and  did  not  yield  in  the  least  to  any 
palliative  treatment  suggested  by  friends  or 
prescribed  by  his  physician. 

On  examining  the  eye  it  presented  a  moder- 
ate degree  of  pericorneal  congestion,  resemb- 
ling that  of  subacute  glaucoma.  The  intra- 
ocular tension  was  only  slightly  increased,  the 
cornea  being  perfectly  clear  and  bright.  The 
iris  ai)peared  somewhat  thickened,  and  pre- 
sented visible  blood  vessels  in  considerable 
numbers.  The  pupil  could  not  be  dilated  in 
the  least  by  atropine  or  scopalamine  ;  neverthe- 
less, he  was  able  to  make  out  with  the  ophthal- 


moscope a  small  portion  of  one  retinal  blood 
vessel  on  a  yellowish  surface  close  behind  the 
lens,  and  inferred  from  this  a  total  detachment 
of  the  retina.  This,  together  with  the  fact  that 
the  pain  was  out  of  all  proportion  to  the 
inflammatory  phenomena,  the  loss  of  vision 
complete  and  the  tension  somewhat  increased, 
rendered  the  diagnosis  of  intra-ocula  sarcoma 
extremely  probable,  notwithstanding  the  pa- 
tient's statements  in  regard  to  the  compara- 
tively recent  origin  of  the  blindness.  Dr. 
BuUer  stated  that  it  was  likely  that  the  growth 
was  of  much  older  date  than  last  spring  ;  two 
or  three  years  at  least  must  have  elapsed  since 
it  commenced,  and  no  doubt  the  blindness, 
more  or  less  complete,  existed  long  before  the 
injury,  but  was  unnoticed  by  him  until  parti- 
cular attention  was  called  to  the  condition  of 
the  eye  at  that  time.  There  was  one  other 
point  of  interest  about  this  case.  Finding  that 
the  pupil  would  not  dilate  with  atropine,  he 
used  the  new  and  stronger  mydriatic  scopala- 
mine. Two  drops  of  a  four  grain  solution 
were  used  in  the  morning,  at  an  interval  of 
about  an  hour,  and  caused  some  vertigo,  but  a 
third  drop  about  5  p.m.  was  followed  by  men- 
tal hallucinations  and  a  sort  of  stupor  which 
lasted  for  several  hours.  The  patient  was 
inclined  to  be  garrulous,  but  talked  incoher- 
ently, and  did  not  seem  able  to  recognize  any- 
one about  him  ;  there  was  also  almost  complete 
loss  of  co-ordination  of  ordinary  muscular  move- 
ments, the  face  was  somewhat  flushed  but  of  a 
good  color,  both  respiration  and  pulse  wt 
about  normal,  and  after  a  night's/  sleep  he 
awoke  the  next  morning  in  his  usuar  he^th. 

In  this  case  the  toxic  effect  oMli/f  scopala- 
mine was  very  marked,  but  app^/e^ly  not  of  a 
dangerous  character. 

The  Pulse  and  RcspiratioK  during  Ether 
Anccsthesia  tenth  Clover  s  Inhaler. — Dr.  Gor- 
don Campbell  read  a  paper  with  the  above 
title,  and  showed  a  number  of  charts  which  had 
been  prepared  by  Drs.  Cameron,  Brown  and 
himself  from  notes  taken  during  anaesthesia. 
The  normal  or  usual  effect  was  shown  to  be  a 
very  considerable  quickening  of  both  pulse  and 
respiration  at  the  outset,  then  gradual  slowing 
of  the  pulse  down  to  the  normal  rate,  but  con- 
tinued rapid  respiration  while  the  anaesthesia 
lasted,  so  that  the  pulse-respiration  ratio  was 
altered.  The  rate  of  the  breathing  was  still  fur- 
ther increased  reflexly  by  certain  manipulations 
on  the  part  of  the  operator.  These  were  : 
stretching  the  sphincter  ani  and  working  with 
the  mucosa  of  tiie  rectum,  sometimes  stretching 
the  perineum,  rough  handling  of  the  peritoneum, 
especially  breaking  down  adhesions  and  work- 
ing with  the  ovaries  and  testes.  The  pulse 
natc  was  increased  by  haemorrhage,  and  both 
l)ulse  and  respirations  by  an  overdose  of  ether. 
This  latter  observation  had  been  worked  out 
experimentally.     Tlic   practical  points  were  to 


THE   CANADA    MEDICAL    RECORD. 


79 


watch  both  pulse  and  respiration  carefully. 
Quickening  of  respiration  alone  was  accounted 
for  reflexly,  and  a  less  amount  of  ether  should 
be  given,  as  otherwise  the  increased  rate  of 
breathing  would  lead  to  an  overdose.  Quick- 
ening of  both  pulse  and  respiration  meant  an 
overdose;  quickening  of  the  pulse  alone  meant 
haemorrhage.  The  results  were  obtained  by 
tabulating  the  notes  of  one  hundred  cases. 

Dr.  Kenneih  Cameron  since  last  Christmas 
had  kept  records  of  forty  cases  in  which  he 
had  administered  ether  by  Clover's  inhaler. 
'J'he  cases  were  all  gyntecological,  and  his  results 
were  almost  identical  with  those  of  Dr.  Camp- 
bell. He  had  noticed  that  the  respirations 
were  always  increased  by  what  might  be  called 
intra-abdominal  reflexes,  such  as  handling  the 
peritoneum,  as  in  tearing  adhesions,  tying  off 
the  ovary  and  its  appendages,  washing  out  the 
abdomen  and  pulling  on  the  round  ligament. 
He  had  had  no  experience  of  reflexes  arising 
from  manipulations  about  the  rectum.  An 
excess  of  ether  was  another  cause  of  increasing 
the  rapidity  of  the  respirations  as  well  as  the 
pulse.  The  pulse  showed  the  same  initial  rise 
with  the  gradual  fall  as  the  administration  pro- 
ceeded. The  chief  cause  for  increased  rapidity 
of  the  pulse  was  haemorrhage. 

The  lesson  to  be  learned  from  the  investiga- 
tion was  that  when  the  respirations  were  in- 
creased, without  any  of  the  recognized  reflex 
causes  being  present  to  account  for  it,  the  anses- 
thetist  should  suspect  an  excess  of  the  ether, 
and  remove  the  inhaler. 

Dr.  George  A.  Brown  had  given  ether  for 
Dr.  Alloway  for  about  three  years,  during 
which  time  he  kept  records,  similar  to  those  of 
Dr.  Campbell,  of  his  cases.  He  had  used 
Allis'  inhaler  for  the  first  year  and  a  half,  after 
that  he  employed  Clover's  inhaler.  His  results 
closely  resembled  Dr.  Campbell's.  As  to  the 
relative  merits  of  the  two  inhalers,  he  thought 
Clover's  had  the  advantage,  inasmuch  as  you 
could  more  accurately  ascertain  the  quantity  of 
ether  being  administered.  Working  with  Allis', 
one  was  apt  to  give  too  much  of  the  drug  at 
the  start,  and  as  a  consequence  did  not  get  the 
sharp  fall  in  the  pulse  that  ought  to  follow  the 
initial  rise,  and  in  fact  the  anaesthetist  often 
discovered  that  he  had  his  patient  deeply  antes- 
thetized  when  a  lighter  degree  would  suffice. 
Still,  he  believed  as  one  became  accustomed  to 
the  use  of  Allis'  apparatus  he  would  be  able  to 
judge  of  the  proper  amount  to  give  at  the 
commencement,  and  the  results  of  both  inha- 
lers would  then  be  practically  alike.  He 
agreed  with  Dr.  Campbell  as  to  the  effect  of 
intra-abdominal  reflexes  upon  the  respirations, 
and  had  had  one  opportunity  of  noticing  the 
truth  of  Dr.  Cameron's  observation  as  to  the 
effect  of  pulling  on  the  round  ligament. 

Dr.  GuRD,  as  an   anaesthetist  of  some   four- 
een  years'   standing  and  of  very  considerable 


experience,  had  used  Clover's  iniialer,  but  not 
exactly  in  the  manner  of  the  pievious  speakers. 
As  to  the  existence  of  certain  regions  which, 
when  irritated,  reflexly  stimulated  the  respira- 
tory centres,  he  thought  there  could  be  no 
doubt;  and  he  believed  that  every  anaesthetist 
must  perforce  soon  become  aware  of  the  loca- 
tion of  these  places  of  extra  excitability.  It 
was  his  custom  never  to  use  the  bag  of  Clover's 
inhaler,  except  when  the  operator  was  m^inipu- 
lating  in  these  regions,  and  he  used  it  then  for 
the  purpose  of  quieting  the  increased  move- 
ments of  the  limbs,  which  were  apt  to  be  thus 
set  up.  Apart  from  this  he  never  felt  justified 
in  using  the  bag  of  the  inhaler,  as  he  believed 
that  pure  ether  was  much  less  injurious  to  the 
patient's  system  than  a  mixture  of  ether  and 
respired  air,  with  all  its  impurities,  whicli  the 
application  of  the  bag  implied.  So  far  as  the 
convenience  of  the  anaesthetist  and  of  the  oper- 
ator was  concerned,  there  could  be  no  doubt 
that  there  was  an  advantage,  as  by  its  means 
the  patient  was  much  sooner  rendered  uncon- 
scious ;  but  he  thought  that  this  was  accom- 
plished at  the  expense  of  the  patient's  vitality. 

Dr.  William  Gardner  stated  that  the  only 
points  in  Dr.  Campbell's  paper  which  he  was 
in  a  position  to  confirm  were  those  which 
related  to  the  reflexes  set  up  while  working  on 
the  peritoneum.  He  was  especially  impressed 
with  the  fact  brought  out  concerning  the  dan- 
ger of  giving  too  much  ether  during  these 
moments  of  unusual  respiratory  excitation. 
The  patient  then  breathes  more  quickly,  and 
hence  is  apt  to  take  more  of  the  drug,  which 
might  easily  constitute  an  excess  if  the  anaes- 
thetist be  not  on  his  guard.  He  further  ex- 
pressed his  satisfaction  at  the  evidence  of  the 
popularity  of  Clover's  inhaler  in  Montreal,  as 
he  considered  himself  as  chiefly  responsible  for 
its  introduction  here. 

Dr.  Alloway  remarked  that  in  the  days  of 
the  old-fashioned  cone  and  sponge,  it  was  a 
matter  of  considerable  anxiety  to  the  surgeon 
as  to  what  was  going  to  take  place  before  the 
patient  was  fully  anaesthetized,  and  that 
throughout  the  whole  operation  his  attention 
was  more  or  less  distracted  from  his  work  by 
the  possibilities  ot  danger  arising  from  the 
anaesthetic.  Now  all  this  was  changed.  He 
knew  that  the  quantity  of  the  drug  administered 
was  accurately  measured,  and  he  felt  the  same 
safety  in  its  use  as  does  the  physician  in  pre- 
scribing within  the  limits  of  the  pharmaco- 
pceial  dose.  The  only  occasion  now  on  which 
he  has  to  inquire  into  the  department  of  the 
anaesthetist  was  the  blocking  of  the  respiratory 
l)assages  by  mucus,  and  here  the  best  plan  is 
to  stop  the  administration  and  allow  the  pa- 
tient to  vomit,  which  may  be  assisted  by  irri- 
tation of  the  fauces. 

Dr.  Evans  referred  to  an  article  he  had 
recently  read,  in  which  much  the  same  views 


8o 


THE  CANADA   MEDICAL   RECORD. 


were  put  forth.  -A  point  mentioned  in  this 
paper  was  the  occasional  occurrence  of  tonic 
spasm  in  the  recti  muscles  of  the  abdomen 
when  complete  ancesthcsia  had  been  induced, 
especially  where  there  was  a  good  deal  of  mucus" 
in  the  trachea.  Substituting  chloroform  for 
ether  for  a  little  while  quickly  overcame  the 
spasm.  He  asked  if  any  of  the  anesthetists 
present  had  observed  this  phenomenon. 

Dr.  F.  J.  Shepherd,  speaking  of  the  advan- 
tages of  etiier  as  an  anaesthetic,  could  not  say 
that  his  experience  was  so  uniformly  favorable 
as  Dr.  Campbell's.  He  thought  in  men  accus- 
tomed to  consume  large  quantities  of  alcohol, 
])henomena  were  noticed  which  were  both  fre- 
quent and  troublesome.  In  some  a  condition 
of  tremor  will  set  in,  and  persist  in  spite  of 
everything  throughout  the  whole  of  the  anaes- 
thesia. Others,  again,  frequently  show  a  ten- 
dency to  hyper-secretion  of  mucus  in  the  tubes. 
In  such  cases  he  questioned,  therefore,  if  it 
would  not  be  better  to  use  choloroform.  Before 
permanently  settling  the  question^  moreover, 
he  thought  it  would  be  desirable  to  have  some 
investigations  made  among  men  as  well  as 
women,  as  all  the  cases  reported  here  to-night 
were,  he  believed,  gynaecological  patients. 

Dr.  Armstrong  al-o  would  like  to  see  these 
investigations  extended  into  that  numerous 
class  of  surgical  patients,  whose  constitutions 
were  not  normal,  but  rather  more  or  less  shat- 
tered as  a  result  of  their  disease  or  accident — 
the  sort  of  cases  which  the  surgeon  gets  in  the 
Montreal  General  Hospital,  especially  those 
emergency  cases  where  an  operation  has  to  be 
performed  within  a  few  hours  after  their  admit- 
tance. One  of  the  most  prominent  features  of 
Dr.  Campbell's  paper  was  the  great  success 
he  had  achieved  by  the  Clover's  inhaler.  He 
himself  had  heretofore  a  strong  dislike  to  this 
method  of  anaesthetising,  especially  as  he  had 
had  sometimes  seen  it  employed,  when  the 
patient  was  forced  to  breathe  vitiated  air  for  as 
much  as  half  an  hour  or  more  at  a  time  ;  still, 
after  listening  to  th.e  results  of  the  extensive 
investigations  laid  before  them  to-night,  he 
thought  no  reasonable  man  could  deny  that, 
when  properly  used,  at  all  events,  the  Clover's 
inhaler  was  a  great  success.  Another  impor- 
tant result  brought  out  by  this  work  was  the 
evident  danger  of  continuing  the  anaesthetic 
when  the  respirations  were  increased  from  any 
cause.  By  so  doing,  the  patient  inhaled  an 
increased  quantity  of  the  drug  ;  and  the  won- 
der is,  when  we  consider  how  little  this  matter 
has  been  attended  to  in  the  past,  why  accidents 
have  not  been  more  frequent.  Every  anaes- 
thetist should  keep  in  mind  the  normal  rate  of 
respiration  under  etlier,  should  know  readily 
all  the  causes  which  might  increase  the  rate, 
and  watch  carefully  whether  any  of  them  be 
operating  when  any  undue  frequency  is  noted, 
so  as  to  satisfy  himself  that  it  is  not  due  to  an 


excess  of  the  drug.  He  should  also  remember 
that  when  the  rate  of  respiration  is  increased, 
the  amount  of  the  drug  consumed  is  also 
increased,  and  the  danger  of  administering  m 
excess  made  greater.  Another  point  made 
manifest  by  these  papers  is  the  apparent 
absence  of  all  injurious  effects  from  prolonged 
administration.  If  this  hold  good  for  that  other 
class  of  patients,  already  alluded  to,  who  are 
not  in  such  good  physical  condition  as  gynae- 
cological patients  generally  are,  it  is  a  very 
important  fact,  and  one  that  must  sensibly  influ- 
ence surgical  procedure.  If  time  is  of  no  conse- 
quence, or  if  it  must  not  be  seriously  regarded  by 
the  surgeon  in  deciding  on  his  operation,  many 
of  our  present  preferences  for  one  operation 
more  than  another  will  have  lost  their  raison 
d'etre.  As  an  illustration,  one  may  mention  the 
fact  that  the  "  Murphy  button  "  owes  its  chief 
superiority  over  the  method  of  suturing  an  intes- 
tinal anastomosis  to  the  saving  of  time  which 
it  allows ;  and  if  this  saving  of  time  is  no  longer 
of  such  paramount  importance,  the  advantage 
of  the  "button"  in  the  minds  of  many  sur- 
geons will  fall  to  the  ground.  The  same 
might  be  said  of  many  other  operations.  Vet, 
according  to  Dr.  Campbell's  statistics,  the 
patient  seems  to  have  been  in  as  good  condi- 
tion at  the  end  of  three  hours  of  ether  anes- 
thesia as  at  the  beginning,  so  far,  at  any  rate, 
as  the  respiration  and  circulation  were  con- 
cerned. If  this  evidence  be  confirmed  by  more 
general  investigation,  Dr.  Armstrong  thought 
that  too  much  credit  could  not  be  given  to  Dr. 
Campbell  for  having  brought  it  to  light. 

Dr.  Buller  believed  that  for  short  opera- 
tionsi  not  requiring  more  than  a  few  minutes  to 
perform,  the  old-fashioned  cone  was  more  ser- 
viceable than  a  Clover's  inhaler.  He  had  been 
accustomed,  in  Utile  operations  performed  in 
his  office,  to  allow  the  patients  to  anesthetize 
themselves.  .This  was  easily  accomplished,  and 
gave  more  satisfaction  to  all  parlies,  as  it  could 
be  done  without  violence  or  vomiting,  and  the 
patients  quickly  recovered  from  its  effects. 
He  also  thought  that  the  members  of  this 
Society  had  an  unnecessarily  serious  impression 
of  the  dangers  attached  to  ether  as  an,  anaes- 
thetic ;•  for  his  part  he  had  been  using  it  for 
years,  and  with  this  simple  apparatus,  had  never 
any  really  serious  difficulty.  He  believed  that 
any  careful  anesthetist,  by  watching  his  patient, 
could  always  detect  any  threatened  untoward 
effect,  and  prevent  its  development  by  allowing 
a  few  inspirations  of  pure  air. 

Dr.  McCoNNELL  found  the  paper  and  charts 
very  instructive.  He  himself  had  been  accus- 
tomed to  use  a  mixture  of  chloroform  and  ether 
in  the  proportion  or  two  to  one  respectively. 
To  a  certain  extent  he  was  prepared  to  admit 
that,  these  results  were  brought  about  by  the 
use  of  the  Clover's  inhaler  ;  but  still  he  thought 
a  careful  anesthetist,  who  watched  closely  the 


THE   CANADA   MEDICAL   RECORD. 


8l 


I)iilse  and  respiration,  might  perform  good  and 
safe  work  with  the  ordinary  cone.  He  would 
hke  to  ask  Dr.  Campbell  if  he  had  made  any 
attempt  to  ascertain  why  the  resjjirations  in- 
creased under  an  excess  of  the  drug.  Is  it 
because  of  some  change  in  the  blood,  or  is  it 
through  some  local  effect  upon  the  respiratory 
mucoui3  membrane  ?  He  saw  an  article  some 
time  ago,  where  it  was  stated  that  nitrogen  pro- 
duced almost  exactly  the  same  results  as  ether. 
If  so,  it  must  have  been  rather  through  the 
deprivation  of  oxygen  than  any  special  action 
of  the  nitrogen  ;  and  was  it  possible  that  in  the 
case  of  the  ether  also,  it  was  the  want  of  oxy- 
gen that  produced  the  increased  respiratory 
action  ?  He  thought  an  investigation  of  these 
points  would  form  an  interesting  study. 

Dr.  Mills  considered  the  papers  valuable, 
apart  from  practical  and  scientific,  as  showing 
evidence  of  concerted  work,  which  he  consi- 
dered only  too  rarely  practised.  It  was  not 
always  the  most  curious  case  which  was  the 
most  valuable  ;  and  it  was  only  frorn  the  con- 
sideration of  a  great  number  of  cases  that  any 
general  hiws  could  be  based.  Another  advan- 
tage to  be  derived  from  the  joining  together  of 
workers  is  that  men  supplement  each  other's 
weaknesses  ;  one  man  may  be  strong  in  com- 
piling statistics,  another  man  strong  in  making 
deductions,  and  in  this  way  the  combinauon 
produces  greater  results  than  could  be  accom- 
plished by  each  individual  acting  separately. 
He  would  like  to  go  into  more  fully  than  the 
present  occasion  allows,  how  Dr.  Campbell's 
work  brings  out  the  question  of  reflexes.  Peo- 
ple sometimes  sneer  at  the  idea  of  reflexes,  but 
he,  for  his  part,  believed  that  the  extent  to 
which  reflexes  have  been  so  far  used  to  explain 
the  phenomena  of  the  higher  animals  is  alto- 
gether inadequate. 

Dr.  Gordon  Campbell,  in  reply  to  Dr. 
Gurd,  who  advocated  only  using  the  bag  when 
the  patient  moved,  said  the  patient  never  ought 
to  be  allowed  to  move  ;  if  he  did  so,  it  was  a  sure 
sign  he  was  only  partially  aiicesthetized. 

In  reply  to  Dr.  Evans'  question  as  to  the 
tenseness  of  the  abdominal  muscles,  he  said 
the  subject  was  too  large  to  go  into  all  the  phe- 
nomena connected  with  anaesthesia  in  one 
evening.  This  abdominal  tenseness  generally 
occurred  at  the  beginning  of  the  administration, 
and  he  believed  the  manner  of  giving  the  ether 
had  something  to  do  with  it.  If  one  com- 
mences by  giving  the  ether  in  a  large  dose,  one 
gets  a  certain  amount  of  spasm  of  the  larynx, 
which  tends  to  spread  over  the  whole  body,  and, 
unless  the  amount  given  is  diminished,  is  kept 
up.  Stopping  the  administration  for  a  little 
while  allows  it  to  pass  off,  and  on  commencing 
again  with  a  weaker  dose  it  does  not  recur. 


Stated  Meetings  November  2/1  d,  1894. 

(i.   r.   GiRDWOOD,  M.D.,    Pkisidknt,   in    riiR 
Chair. 

.  /  Case  of  (rori/ig  by  an  Ox  wit  It  Wound  of 
PiOivcI. — Dr.  Shepherd  exhibited  a  patient 
who  had  been  severely  gored  by  an  ox,  and  the 
intestine  and  mesentery  wounded.  The 
patient,  a  French-Canadian.,  aged  63,  whilst 
driving  cattle  on  board  one  of  the  steamships 
on  the  night  of  September  25th,  1894,  was 
knocked  down  and  severely  gored  by  one  ot 
them.  He  was  immediately  brought  to  the 
Montreal  General  Hospital,  and  Dr.  Shepherd 
was  summoned.  On  arrival  he  found  the  man 
suffe-ing  considerably  from  shock  ;  the  right 
testicle  was  exposed,  and  a  large  wound,  on  the 
left  side  of  the  abdomen,  extended  from  the 
spine  of  the  pubis  upward  and  outward  several 
inches  ;  through  this  wound  protruded  some  ten 
to  twelve  feet  of  bleeding  small  intestine 
coVered  with  dirt.  The  intestine  was  washed 
and  then  examined.  It  was  found  that  the 
mesentery  was  perforated  and  torn  in  eight  or 
nine  places,  and  on  disturbing  the  clots  the 
vessels  bled  profusely.  These  were  secured, 
and  the  mesentery  brought  together  with  Lem- 
bert's  sutures.  The  intestine  was  torn  com- 
pletely through  in  only  one  place,  but  in  several 
other  spots  the  outer  and  middle  coats  were 
torn  and  the  mucous  membrane  extruded. 
After  securing  the  injured  parts  with  a  con- 
tinuous Lembert,  the  bowel  was  pulled  out  for 
several  feet  and  found  normal,  and  then  the 
whole  was  returned  into  the  abdomen.  The 
abdominal  walls  were  now  attended  to,  and  it 
was  found  that  the  wound  in  the  muscles  was 
of  greater  extent  than  that  in  the  skin,  which 
had  evidently  been  considerably  stretched — to 
suture  the  torn  muscles  the  wound  had  to  be 
extended  upwards  and  outwards.  The  differ- 
ent structures  were  sutured  separately,  the 
peritoneum  with  catgut  and  the  skin  with  horse 
hair. 

The  wound  in  the  peritoneum  was  most  in- 
ternal, a  little  more  external  was  the  wound  in 
the  muscles  and  more  external  still  the  skin 
wound  ;  so,  in  this  way^  as  each  structure  was 
brought  together,  the  level  of  the  sutures  was 
different.  Although  a  considerable  portion  of 
the  scrotum  was  torn  completely  off,  yet  suffi- 
cient skin  remained  to  cover  the  testicles.  A 
drainage  tube  was  introduced  into  the  perito- 
neal cavity,  and  the  wound  dressed  with  gauze 
and  absorbent  cotton. 

The  patient  went  on  well,  and  never  had  a 
bad  symptom.  The  drainage  tube  was  removed 
On  the  second  day.  The  only  untoward  symp- 
tom that  ensued  was  some  sloughing  of  the 
wound  made  by  the  horn  ;  this  was  no  doubt 
due  to  over-stretching.  The  man  was  in  excel- 
lent condition,  and  had  not  the    slightest  ten- 


82 


THE   CANADA   MEDICAL   RECORD. 


dency  to  hernia,  'ihe  skin  wound  was  not 
completely  healed  owing  to  ihe  sloughing  which 
had  occurred,  but  the  deeper  parts  were  quite 
solid. 

A  Case  of  Mi'i/ico-Lci^al  Inteicst. — Dr.  J.  A. 
Springle  showed  the  genital  organs  of  two 
little  girls,  12  and  14  years  of  age,  who  had 
been  violated  and  murdered  four  years  before. 
Foiyi/iuty/as. — Dr.  J.  Chalmers  Cameron 
exhibited  two  children  of  the  same  family  show- 
ing this  condition  : — 

First  child,  four  days  old. 
Hands — Supernumerary  fingers  on  each  hand 
springing  from  the  outer  border   of   the    little 
finger.     Both  thumbs  broad. 

Feet — Supernumerary  great  toe  on  each  foot 
and  a  supernumerary  little  toe  on  the  left  foot. 
A  web  exists  between  the  first,  second  and 
third  toe  of  each  foot. 

Second  child,  i  year  and  9  months  old. 
Hands     had    supernumerary  little    fingers, 
which  were  amputated  soon  after  birth. 

Right  thttmb  very  broad,  with  a  distinct  fur- 
row down  the  centre. 

On  left  '  and  a  double  thumb. 
Feet  similar  to  those  of  the   other  child,  ex 
cept  the  web  extended  up  almost  to  the  end  of 
the  toes.     On  the  left  foot  are  seven  toes;  on 
the  right  six  toes. 

The  father  of  these  children  presented  the 
following  peculiarities  : 

Right  hand — Broad  thumb,  double  the  nor- 
mal breadth  ;  nail  depressed  in  centre,  but  de- 
pression did  not  extend  down  the  thumb  below 
nail. 

Between  thumb  and  index  finger  is  a  web,  ex- 
tending as  high  as  the  web  of  the  other  fingers. 
A  sixth  finger  projecting   from  the   little  fin- 
ger. 

Left  hand — Same  as  right,  except  that  there 
was  a  web  running  between  first,  second  and 
third  fingers  as  high  as  the  joint  between  first 
and  second  phalanx. 

Dr.  Shepherij  remarked  that  the  subject  of 
polydactylism  was  a  very  complicated  one. 
The  occurrence  of  supernumerary  digits  may 
be  explained  by  two  theories:  (1)  That  it  is 
due  to  reversion  or  atavism  ;  (2)  reduplica- 
tion or  repetition  owing  10  excess  of  germative 
material  (Blastogenic).  By  the  latter  theory, 
the  occurrence  of  more  than  seven  digits  is  ex- 
plained, and  the  doubling  of  the  bones  and 
muscles  of  the  extremities.  The  theory  of  re- 
version is  applicable  to  those  cases  of  super- 
numerary digits  occurring  either  on  the  inner  or 
outer  side  of  the  man  us  or  pes.  Anatomists 
of  late  have  been  much  inlere^ted  in  the  theory 
advocated  l.y  Prof,  liurdelebtn,  viz.,  that  the 
l)entadaciyle  extremity  has  been  preceded  by  a 
hepta-dactyle  form,  that  is,  that  the  present  five 
digit  limbs  were  preceded  by  those  carrying 
seven  digits,  and  that  the  sui>pressed  digits 
were,  one  in    succession   to  the    5th,  the  post- 


minimus,  and  one  in  succession  to  the  ist,  the 
J  re-pollex.  'I'his  would  explain  the  occurrence 
of  these  marginal  structures,  such  as  the  i)isi- 
form  bone  and  the  radial  sesamoid  of  animals, 
and  also  the  occasional  re-appearance  of  cer- 
tain marginal  musdes  in  rudimentary  form. 
Supernuiiierary  digits  are  very  common  in  cats 
and  pigs  ;  in  pigs  the  supernumerary  digits  are 
only  found  in  the  fore  limbs,  whilst  in  all  other 
animals  they  are  found  in  both  fore  and  hind 
limbs.  The  horse  occasionally  has  supernume- 
rary digits,  and  the  sheep  much  more  rarely. 
The  condition  is  markedly  hereditary,  as  evi- 
denced by  the  cases  before  the  Society.  In 
conclusion.  Dr.  Shepherd  regretted  that  the 
subject  was  too  large  a  one  to  permit  him  to  go 
into  it  at  sufficient  length  to  make  it  intelligible 
to  the  members. 

Dr.  Girdwood  mentioned  instances  in  cats 
of  the  reduph'cation  of  parts.  He  had  a  cat 
possessed  of  an  extra  finger,  both  in  the  fore 
and  hind  leg,  and  the  progeny  of  this  cat  was 
likewise  endowed. 

Dr.  Proudeoot  had  a  cat  with  four  well 
marked  tars,  out  of  whose  litter  of  seven,  five 
of  the  kittens  had  similar  supernumerary  e  rs. 

Excision  of  Maxilla. — Dr.  Armstfong 
brought  before  the  members  a  man  whose  right 
maxilla  hs  had  excised  for  sarcoma.  The 
whole  maxilla  was  removed,  includif.g  the  whole 
or  part  of  the  tbllowing  bones,^  lachrymal,  ma- 
lar, orbital  plate,  superior  maxilla,  palate  and 
ethmoid.  The  disease  was  of  a  very  progres- 
sive malignant  character.  It  began  to  grow  in 
December  last  ;  the  first  symptom  noticed  was 
pain  in  the  teeth,  for  which  he  had  some  teeth 
removed  without  getting  relief.  Next  he  was 
troubled  with  the  tears  running  down  the  cheek, 
evidently  denoting  the  plugging  of  the  lachry- 
mal duct.  The  third  symptom  which  appeared 
was  the  pushing  forward  of  the  eye-ball.  At 
this  time  his  teeth  were  reir.oved,  under  the  im- 
pression that  there  might  have  been  some  ul- 
ceration about  the  roots  to  account  for  the 
symptoms,  but  without  result.  The  antrum  of 
Highmore  was  next  explored  in  the  hope  of 
finding  pus,  but  with  like  success.  The  swell- 
ing continued,  as  also  the  pain,  to  grow  worse, 
and  finally  the  case  coming  under  Dr.  Arm- 
strong's notice,  he  diagnosed  a  sub-periostial 
sarcoma  of  a  pretty  rapid  growth,  and  advised 
excision.  A  sj)ecimen  had  been  submitted  to 
Dr.  Adami  for  examination,  and  the  following 
report  received. 

Section  shows  it  to  be  an  end  Jthelioma,  i.e., 
a  malignant  connective  tissue  tumor  present- 
ing an  alveolar  arrangement  which  in  parts  is 
with  difficulty  distinguished  from  an  epithelio- 
matous  growth. 

There  are,  however,  no  true  cell  nests,  the 
sfroma  dues  not  tally  with  that  of  a  true  epi- 
thelioma, and  the  cells  of  the  alveoli  have  a 
sarcomatous  appearance. 


THE   CANADA   MEDICAL   RECORD. 


83 


The  tumor  is  evidently  rapidly  growing. 
When  the  primary  growth  occurred  could  not 
be  determined  from  the  specimen. 

Dr.  Roddick  enquired  concerning  the  prog 
nosis  of  Dr.  Armstrong's  case,  and  agreed  with 
the  latter  that  it  was  very  serious. 

Maternal  Impressions — Missed  Abortion — 
Monstrosity  {Janiccps). —  Dr.  Gurd  exhibited 
a  monstrosity,  a  foetus  of  about  the  thirteenth 
week,  having  fusion  of  two  bodies  with  a  single 
head.  It  had  four  arms  and  four  legs,  all  well 
formed.  No  external  genitals  were  visible,  and 
the  umbilical  cord  was  given  off  low  down  be- 
tween one  pair  of  legs.  There  was  also  a  com- 
paratively large  spina  bifida.  The  fcetus  was 
partly  mummified  owing  to  its  having  been  re- 
tained six  weeks  after  its  death. 

The  mother  had  all  the  usual  signs  and  symp- 
toms of  pregnancy  for  three  months,  when  these 
suddenly  left  her,  and  she  then  had  all  the 
symptoms  of  one  carrying  a  dead  fcetus.  Dr. 
Gurd  said  that  this  case  would  strengthen  the 
faith  of  those  who  believed  that  strong  maternal 
impressions  caused  marks  and  deformities. 
One  afternoon  shortly  after  conception,  the  mo- 
ther went  to  Sohmer  Park,  and  there  witnessed 
the  performance  of  some  acrobats.  Their  tumbl- 
ings so  affected  her  that  she  told  her  husband 
she  could  not  look  at  them.  The  mother  asked 
if  this  could  in  any  way  have  made  her  lose  her 
baby.     She  never  knew  of  its  being  deformed. 

Dr.  Lapthorn  Smith  thought  the  term  jani- 
ceps  was  not  very  appropriate  in  this  case,  as  it 
ought  to  denote  a  double-headed  body  or  dou- 
ble-faced head,  instead  of  whick,  this  specimen 
had  only  one  head,  the  doubling  being  confined 
to  the  extremities. 

Dr.  Gurd,  in  reply,  said  he  recognized  the 
inconsistency  of  the  name  with  the  condition, 
but  he  had  looked  up  a  number  of  authorities, 
and  they  all  agreed  in  describing  it  by  this 
term,  so,  though  unsatisfied,  he  was  obliged  to 
follow  their  example. 

Paralysis  in  Children. — Dr.  Macphail  read 
a  paper  on  this  subject  as  follows  : 

During  the  past  two  months,  through  the 
intervention  of  Dr.  C.  S.  Caverley,  President  of 
the  Board  of  Health,  and  his  colleague,  Dr.  H. 
H.  Swift,  I  was  able  to  make  some  observa- 
tions upon  an  epidemic  of  "  paralysis  in  child- 
ren," which  occurred  in  the  State  of  Vermont. 
The  epidemic  commenced  late  in  June,  increas- 
ed in  July  and  culminated  in  August,  and 
though  new  cases  are  cropping  up,  the  malady 
has  now  almost  abated.  I  obtained  the  notes 
of  ninety-one  cases  out  of  one  hundred  and 
twenty  which  were  affected. 

At  first  the  belief  was  held  that  the  outbreak 
was  one  of  cerebro-spinal  meningitis,  and  there 
were  several  cases  presenting  the  characteris- 
tics of  this  disease.  But  on  examination  it 
appeared  that  such  cases  were  very  few,  and 
in  many  there  were  no  symptoms  at  all  beyond 


paralysis.  There  was  a  general  absence  of 
retraction  of  the  head  and  flexing  of  the  trunk. 
The  sensory  symptoms  were  not  prominent, 
the  headache  was  chiefly  frontal,  and  beyond 
some  slight  delirium  of  the  ordinary  febrile 
type  there  were  no  psychical  manifestations. 
The  cutaneous  symptoms  were  absent  or  unim- 
portant, and  while  in  many  cases  tlierc  were 
indefinite  rashes,  in  only  one  were  there  petc- 
ciiiaj,  in  none  herpes-labialis  mottling,  purple 
spots  or  the  other  undoubted  cutaneous  mani- 
festations of  "  spotted  fever." 

The  sequalffi  and  complications  were  also 
different.  There  was  no  account  of  pleurisy  or 
pericarditis,  and  in  only  one  cise  pneumonia. 
Nei'her  the  auditory  nor  any  of . he  cranial  nerves 
were  permanently  affected.  The  eye  symp- 
toms were  wholly  of  central  origin,  no  ophthal- 
mia, no  conjunctivitis,  no  keratitis,  no  perma- 
nent impairment  of  vision.  From  an  examina- 
tion of  the  records  of  all  the  epidemics  of 
cerebro-spinal  meningitis,  and  an  estimate  of 
such  authorities  as  Randolph,  Wilson,  Nie- 
meyer,  Knapp  and  Kreitmair,  it  would  appear 
that  the  eye  symptoms  alone  were  sufficient  to 
dififeientiate  the  present  malady  from  cerebro- 
spinal meningitis.  Indeed,  Hirsh  affirms  that 
"Conjunctivitis  is  almost  always  a  constant 
condition." 

I  will  set  down  brief  notes  of  a  few  cases 
typical  of  groups  into  which  the  series  seemed 
to  fall. 

S.  C,  a  boy  five  years  old,  complained  17th 
June  of  headache,  chiefly  frontal,  with  nausea 
and  vomiting,  a  temperature  of  102  degrees 
and  a  pulse  of  115.  This  continued  for 
twenty-two  hours,  and  was  succeeded  by  sore- 
ness in  the  arms  and  legs,  loss  of  reflexes,  wiih 
generally  increasing  paralysis,  culminating  after 
twenty-four  hours  in  a  completely  powerless 
condition  of  both  lower  and  both  upper  extre- 
mities, which  still  persists. 

A.  B.,  a  delicate  girl  of  twelve  years,  with  a 
slight  left  lateral  spinal  curvature,  fell  sick  of 
an  attack  resembling  indigestion,  with  coated 
tongue  and  marked  constipation.  Gradually, 
without  alarming  symptoms,  paralysis  super- 
vened, and  in  two  days  both  arms  and  legs 
were  useless.  After  five  weeks  there  is  no  sign 
of  improvement. 

In  this  case  there  was  a  real  arthritis  quite 
as  intense  as  in  an  ordinary  attack  of  acute 
rheumatism,  the  pain  not  merely  "supposed 
to  be  in  the  joints."     (Gowers.) 

Boy,  seven  years  old,  4th  July,  had  a  temper- 
ature of  T03  degrees,  and  a  pulse  of  120  for 
three  weeks.  The  temperature  suddenly 
dropped  to  97,  and  the  pulse  to  50,  The  knee 
joints  now  became  painful  and  swollen,  as  well 
as  the  elbow  and  shoulder,  paralysis  of  the  left 
upper  and  left  lower  extremities  followed,  and 
still  persists. 

In   this  case  the  preliminary  symptom  was 


84 


THE    CANADA   MEDICAL    RECORD. 


double  vision.  A  girl,  eleven  years  old,  sud- 
denly developed  this  condition,  and  for  three 
days  was  slightly  unwell.  Next  morning  she 
was  unable  to  gel  out  of  bed  on  account  of 
complete  i»aralysis  of  the  left  arm  and  leg. 
Fever  with  delirium  followed  for  four  days 
when  the  symptoms  abated,  and  now  the  limbs 
show  some  improvement.  In  this  case  the 
menstrual  function  was  established  during  the 
progress  of  the  disease. 

In  other  instances  there  were  no  pre- 
monitory sym|)tomG,  and  without  warning,  the 
children  would  "stumble,"  and  on  examina- 
tion one  or  other  of  the  limbs  would  be  dis- 
covered in  a  paralytic  condition. 

The  following  may  be  taken  as  types  of  the 
fatal  cases  : 

S.  G.,  an  Italian  boy  of  four  years  old,  on  the 
2 1  St  July  became  sleepy,  and  complained  of 
headache.  He  was  found  to  have  no  fever, 
but  with  a  pulse  of  45  slow,  hobbling  in 
character  and  intermitting  every  fifth  beat. 
This  continued  four  days,  when  a  slight  im- 
provement was  noticed,  internal  strabismus 
occurred,  but  the  child  made  a  complete 
recovery,  so  far  as  symptoms  were  concerned, 
on  the  seventh  day.  He  was  then  allowed  to 
divert  himself  in  the  hot  sun  in  company  with  a 
goat,  when  ail  the  original  symptoms  returned, 
headache,  scjuint,  halting  pulse  and  drowsi- 
ness. This  was  the  last  of  August,  by  the  first 
of  September  he  was  worse  than  at  any  pre- 
vious lime,  but  yet  had  no  fever.  Next  day  the 
knee-jerk  was  absent,  but  the  plantar  reflex 
was  letained,  as  well  as  the  cremasteric.  The 
legs  now  became  paralysed,  and  by  the  third 
of  ^-eptember  the  paralysis  was  general,  the 
eyes  half  closed,  the  pupils  dilated  and  un- 
equal, a  temperature  of  105  degrees.  The 
child  died  at  three  o'clock  the  same  afternoon. 

Hilding  A.,  a  Swedish  child,  twenty  months 
old,  on  the  31st  August  was  stricken  witli 
fever  of  103  degrees  and  pulse  of  120.  The 
restlessness  was  extreme,  the  child  moaning 
and  tossing  its  limbs,  but  quite  conscious. 
The  head  was  slightly  retracted,  and  the  pupils 
contracted  unevenly.  Next  day  the  general 
symptoms  were  improved,  but  the  child  con- 
tinued restless  and  in  a  highly  excitable  con- 
dition. The  second  of  September  the  fever 
had  disappeared,  but  the  restlessness  increased 
with  clonic  spasm,  strong  grinding  of  the  teeth 
and  paralysis  of  the  left  leg.  Next  day  the 
temperature  rose  to  104,  the  sfjasm  increased, 
and  general  paralysis  supervened.  The  child 
died  in  the  afternoon. 

In  view  of  the  fact  that  in  many  cases  of 
cerebro-spinal  meningitis  the  lance-shaped 
coccus,  similar  in  all  respects  to  the  pneumo- 
coccus,  has  been  found,  which  Cornell  and 
Babes  regard  as  the  cause  of  both  diseases,  it 
is  worth  remarking  that  pneumonia  was  present 
in  only  one  case. 


E.  F.,  a  boy  aged  four  years,  was  affected  on 
the  8th  of  August,  after  a  slight  preliminary 
illness,  with  paralysis  of  both  legs,  and  two 
days  later  developed  pneumonia.  Both  con- 
ditions subsided,  and  now  the  child  is  in  a  fair 
way  of  recovery. 

In  a  few  the  onset  was  accompanied  by 
symptoms  of  transient  meningitis.  Gowers 
believes  that  such  condition  must  be  regarded 
as  a  coincident  effect  of  a  common  cause. 

I  have  also  notes  of  six  cases  in  adults,  of 
which  three  were  fatal,  in  two  the  paralysis 
persists,  the  other,  a  man  of  seventy,  recovered, 

The  ages  were  nineteen,  twenty-four,  twenty- 
seven,  thirty-five,  thirty  six  and  seventy  years. 

For  example  :  S.  J.,  a  lad  19  years  old,  com- 
plained of  pain  in  the  head  and  back,  a  pulse  of 
100  and  a  temperature  of  102  degrees.  The 
fever  subsided  on  the  fourth  day,  the  pulse  fell 
to  56,  and  all  pain  disappeared.  The  right 
arm  now  became  paralysed,  and  by  next  morn- 
ing the  pulse  was  at  38,  the  temperature  97, 
the  extremities  cold.  Complete  paralysis 
developed  during  the  day,  and  in  the  afternoon 
the  young  man  died. 

The  muscles  in  every  marked  case  showed 
the  degenerative  reaction  in  a  character- 
istic manner.  The  loss  of  faradic  irritability 
was  observed,  and  in  many  cases  absolute, 
while  the  reaction  to  the  constant  current  was 
increased.  The  muscles  were  variously  affected. 
In  some  cases  the  whole  arm  was  paralysed, 
in  some  only  the  intrinsic  muscles  of  the  palm, 
but  the  combinations  of  the  different  groups 
affected  were  endless.  After  an  exhaustive 
tabulation  of  the  muscles  and  groups  affected, 
I  was  unable  to  discover  any  combinations 
which  seemed  to  preserve  any  definite  order. 
In  the  legs  the  extensor  group  was  injured 
most  frequently,  and  sometimes  there  was  a 
functional  association.  The  paralysis  in  every 
CISC  was  motor,  and  tlie  only  disturbance  of 
sensation  was  hyper^esthesia. 

The  distribution  of  the  paralysis  was  as 
follows,  reduced  to  percentage  : 

Left  arm  alone, 2 . 

Right  arm  alone 4. 

Both  arms  alone 2. 

Right  leg  alone 7. 

Left  leg  alone  26. 

Both  legs  alone. 45. 

Left  leg  and  left  arm 8. 

Right  leg  and  right  arm 3. 

Both  legs  and  left  arm 2. 

l^oth  legs  and  both  arms 4. 

Right  thigh 2. 

Tiic  infection  was  confined  to  a  definite  area 
fifteen  miles  long  and  twelve  in  breadth,  with 
the' range  of  the  Green  Mountains  on  the  east, 
but  no  natural  boundary  on  the  other  side. 
The  city  of    Rutland    is    in  the  centre  of  the 


THE  CANADA  MEDICAL  RECORD. 


85 


area.     It  would  be  hard  to  discover  a  region  in 
which  a   disorder    had   less    license  to  become 
epidemic  ;  the  whole  district  lies  upon  a  series 
of  terraces,  and  increased  safety  did  not  come 
with  elevaiion.  Indeed,  four  cases  occurred  on 
the  very  ridge  of  the  Green   Mountains,    at  an 
elevation  of  1,500  feet,   and  the  line  of  the  four 
dwellings    extended    over     half  a    mile.     The 
water  supply    was  different   in  each  of  the   four 
cases,    namely,  from    springs  out    of  the  moun- 
tains.    The  range  referred  to  definitely  limited 
the  infected  area,    which    occurred  in    a  region 
with  faults    and    dislocations     in     the    earth's 
crust  and  profound  breaks  in  the  whole   strata, 
while  on  the  other    side  of  the    mountains  tlic 
country  is  level    and   unfaulted.     Neither  over- 
crowding   of   habitations    nor   any  oi  the  evils 
usually  accompanying  or  flowing  from  this  con- 
dition  were  fLictors    in  the  present   case,  since 
only  in  four  families  was    more  than   one  mem- 
ber affected.     It  was  quite  usual  for  children  to 
sleep  with  those  who   were  affected  and  them- 
selves remain    entirely  free    from  the  disease. 
No  isolation  was  practised,  nor  did  such  precau- 
tion appear   to  be  of  the    slightest    value.     In- 
deed, the  brunt    of  the    disease    fell    upon  the 
purely  rural  portion  of  the  community.     There 
was  nothing    discoverable  in  the   domestic  and 
personal    hygiene      of    those     attacked.     The 
houses  were    all  detached,  and  in    most  cases 
there  was  nothing  in  the  nature  of  privy  or  cess 
pool.     Nor    had     penury    any      part    in    the 
epidemic.     The  district    is    one    of   the  most 
thriving    in    the  United  States,    and  has  been 
settled  for   a   century   and  a   half.     The  food, 
water  and    milk    supply   were    examined    and 
were  found   above    reproach.     The   food   and 
milk  is  drawn   from  the    neighboring  farms    or 
from  the    farms    in    which    the     patients  lived. 
The  veterinary    surgeons    have    remarked    no 
unusual   occurrence    amongst    the    cattle,    but 
twelve  horses  died  of  what  was  called  cerebro- 
spinal   meningitis.     I  was    unable    to    procure 
any  reliable  account  of  these  cases.     The    sum- 
mer was  dry  and   hot,   the    springs   scanty  and 
the    surface   water   low.     The    rainfall    for  the 
three  months  was    only    6,58    inches,   against 
11.95  ^^st  year,    and  15.04   the   year  before,  or 
an  average  of  11.2  for  the  last   47  years.     The 
average  temperature  was  64.3  degrees,  last  year 
64.4,   the    year   before    65.2,     and    65.4  on   an 
average    for    the    last  47    years.     Cases  were 
found  amongst  children  of  American,    Swedish, 
Italian,  French,  Irish  and  Jewish  parentage,  so 
that   nationality   appeared  to  have  no    bearing. 
There  is  in  one  place   a   colony  of  a  thousand 
Italian  marble  cutters,  but   amongst  them  there 
were  only  two  cases. 

The  following  table  shows  the  results  reduced 
to  percentages : 

Fatal  cases 13. 

Recovered 25. 


Improved  30. 

Unimproved 32. 

CONCLUSIONS. 

In  the  outset  one  has  to  make  the  humilia- 
ting admission  that  no  usetul  pathological 
results  were  obtained.  In  no  case  was  an 
autopsy  permitted,  and  there  is  no  authority  in 
the  State  of  Vermont  to  enforce  the  demand. 
The  examination  of  the  blood  and  excreta  was 
negative. 

The  diagnosis  is  yet  uncertain,  as  most  diag- 
noses are  which  are  based  upon  clinical  consi- 
derations alone  and  unsupported  by  the  results 
of  a  pathological  examination. 

It  niust  rest  between  cerebro-spinal  menin- 
gitis, multiple  neuritis,  poliomyelitis,  or  a  com- 
bination of  the  last  two. 

1.  Cerebro-spinal  meningitis  may,  I  think, 
be  set  aside  at  once  under  the  force  of  the  facts 
already  alluded  to.  Epidemics  of  this  disease 
are  common  enough,  and  its  general  course  is 
definite  with  a  special  symptomatology.  In  the 
present  case  there  was  an  almost  entire  lack  of 
those  symptoms,  and  there  were,  besides,  mani- 
festations which  have  never  been  noticed  in 
epidemics  of  cerebro-spinal  meningitis. 

2.  H.  Openheim,  Berlin,  in  his  work  on 
diseases  of  the  nervous  system,  emphasizes  the 
view  that  poliomyelitis  is  due  to  an  mfective 
micro-organism,  and  in  the  present  epidemic 
there  was  much  evidence  pointing  in  the  same 
direction.  Indeed,  Medin,  of  Stockholm,  has 
reported  what  he  considers  as  an  undoubted, 
epidemic  of  poliomyelitis,  there  being  44  cases. 
There  is  a  strong  temptation  to  regard  the 
present  outbreak  as  of  a  similar  nature.  Cli- 
nically the  course  of  the  disease  much  resem- 
bled poliomyelitis,  as  a  reference  to  the  cases 
makes  clear.  There  was  the  initial  feverish- 
ness,  aching  pains,  abrupt  paralysis  of  the 
nature  commonly  known  as  "  infantile,"  indeed 
the  distribution  of  the  paralysis  is  highly  char- 
acteristic. If  it  were  not  for  the  disturbance 
in  the  vagus,  one  would  have  no  hesitation,  on 
clinical  grounds,  in  pronouncing  the  epidemic 
one  of  poliomyelitis.  The  mode  of  onset,  the 
paralysis  itself,  the  age  of  patients,  the  season 
at  which  the  epidemic  occurred,  the  distribu- 
tion of  the  paralysis  and  the  subsequent  beha- 
vior of  the  muscles,  all  pomt  to  this  disease. 
Besides,  it  is  not  uncommon  to  have  cerebral 
disturbance  in  poliomyelitis,  convulsions  and 
coma,  and  even  diplopia  has  been  noted.  In 
the  cord  of  a  child  dead  of  this  disease,  the 
lesion  is  not  confined  to  the  cells  of  the  ante- 
rior horn  ;  there  may  be  a  general  ha^morrhagic 
myelitis  and  even  obvious  meningeal  involve- 
ment. There  may  also  be  pain  referred  occa- 
sionally to  the  course  of  the  nerves  and  simu- 
lating a  peripheral  neuritis.  In  an  epidemic, 
including  so  many  cases,  it  is  not  probable 


86 


THE  CANADA  MEDICAL  RECORD. 


that  they  would  all  adhere  to  the  classical 
standard,  and  it  is  to  be  expected  that  some 
would  overflow  into  the  class  of  neuritis  or 
cerebro-spinal  meningitis. 

3.  The  evidence  in  favor  of  the  outbreak 
being  due  to  peripheral  neuritis  rests  upon  the 
disturbance  in  the  vagus.  But  if  one  regards, 
with  Gowers,  "Symmetrical  weakness  of  the 
anterior  musrles  situated  in  the  forearm  and  in 
the  corresponding  muscles  in  the  lower  limb," 
as  the  leading  motor  symptom,  then  it  will  not 
explain  the  j^resent  malady  since  it  was  absent 
in  55  per  cent,  of  the  cases.  Indeed,  the 
paralysis  was  "  characteristically  random  in 
distribution,"  that  is  characteristic  of  poliomy- 
elitis, and  Gowers  further  affirms  that  the  nerve 
trunks  are  sometimes  probably  inflamed  in  the 
latter  affection. 

Finally,  one  is  driven  to  the  conclusion  that 
the  cases  constituting  the  epidemic  mainly 
followed  the  type  of  poliomyelitis,  but  that  in 
some  there  were  elements  strongly  suggestive 
of  multiple  neuritis,  either  as  an  independent 
affection  or  the  common  results  of  a  common 
cause. 

Dr.  James  Stewart,  on  being  asked  by  the 
President  to  give  his  opinion  on  the  nature  of 
the  disease  described  in  Dr.  Ma^phail's  paper, 
said  ii  was  very  difficult  to  express  an  opinion 
as  t')  the  pathology  of  such  a  very  curious  epi- 
demic, without  giving  the  subject  more  thought 
than  could  be  expended  in  the  course  of  listen- 
ing to  the  paper  being  read.  He,  however, 
considering  that  the  chief  symptoms  appeared 
to  be  mainly  of  a  paralytic  nature,  suggested 
the  possibility  of  the  disease  being  really  a 
peripheral  neuritis.  This  disease  sometimes 
occurred  epidemically,  and  was  especially  likely 
to  do  so  in  malarial  districts-  In  the  East 
Indies,  for  instance,  many  cases  of  peripheral 
neuiiiis  are  attributed  to  the  direct  effect  of 
the  Plasmodium.  In  Dublin  at  present  they 
are  suffering  from  an  epidemic  of  a  paralytic 
nature,  which  is  nothing  more  than  a  marked 
perij)heral  neuritis.  In  this  connection,  he 
would  like  to  ask  Dr.  Macphail,  whether  or  not 
any  examination  of  the  blood  had  been  made, 
as  in  cases  of  neuritis,  such  as  he  had  referred 
'to,  micro-organisms  were  invariably  found,  and 
were  capable  of  reproducing  the  disease  when 
injected  into  other  animals. 

Dr.  Macphail,  in  reply  to  Dr.  Stewart,  said 
the  blood  had  been  examined  in  many  in- 
stances, but  always  with  negative  results.  He 
had  attended  four  cases,  which  ended  fatally, 
but  he  could  not  secure  a  post-mortem.  Several 
New  York  physicians  were  also  on  the  ground, 
and  had  carried  on  some  investigations  of  the 
disease,  which  he  had  no  doubt  would  subse- 
quently be  given  to  the  profession;  but,  so  far 
as  he  could  learn,  no  definite  tlata  as  to  the 
])atliological  nature  of  the  trouble  had  been 
obtained. 


Dr.  McCoNNELL  inquired  from  Dr.  Macphail 
whether  atrophy  of  the  muscles  followed  the 
paralysis,  and  was  answered  :  "Yes,  in  every 
case."  He  then  commented  on  the  nature  of 
the  disease,  and  remarked  that  it  seemed  to  be 
an  epidemic  of  a  local  variety,  and  was  pro- 
bably caused  by  some  micro-organism.  He  did 
not  agree  with  Dr.  Stewart  in  regarding  it  as  a 
peripheral  neuritis,  but  was  more  inclined  to 
look  upon  it  as  a  toxic  affection  of  the  spinal 
cord,  confined  to  the  anterior  horns,  probably 
an  anterior  poliomyelitis  with  involvement,  in 
some  cases,  of  the  cranial  motor  nuclei.  The 
symptoms  here  seemed  to  be  confined  to  the 
motor  functions  altogether,  and  were  mostly 
sudden  in  their  onset,  whereas,  were  it  a  neuritis, 
one  would  expect  some  sensory  troubles,  such 
as  pain,  tingling,  hyperaesthesia  or  anesthesia 
and  the  paresis  or  paralysis  coming  on  gradu- 
ally. 

Dr.  Mills  thought  Dr.  Macphail  had  here 
compiled  a  great  deal  of  valuable  material,  and 
presented  it  in  a  form  to  be  grasped  by  all. 
He  hoped  this  line  of  work  would  be  encour- 
aged, and  the  custom  of  collecting  a  large 
number  of  cases  of  some  disease  be  continued. 


Iro^rtBS    of    Bcitnct. 


WILLIAM  THOMAS   GREEN   MORTON, 
M.D. 

William  Thomas  Green  Morton,  M.D.,  med- 
ical student,  dentist  and  physician,  and  the 
recent  recipient  of  Massachusetts'  honor,  was 
born  in  Carlton,  Mass.,  August  9,  1819,  and 
died,  aged  forty-eight,  in  New  York  city,  July 
15,  1868.* 

In  184c,  at  the  age  of  twenty-one,  he  was  a 
student  in  the  "  Baltimore  College  of  Dental 
Surgery,"  a  chartered  organization  connected 
with  the  \Vashington  University  of  Medicine  of 
Baltimore. 

Subsequently  he  engaged  in  the  practice  of 
dentistry  in  Boston,  in  the  meantime  assidu- 
ously pursuing  his  studies  to  receive  a  medical 
degree. 

March  20,  [844,  he  entered  his  name  as  a 
student  of  medicine  with  Dr.  Charles  T.  Jack- 
son of  lioston. 

In  November,  1844,  he  entered  the  Harvard 
Medical  School  in  Boston  in  regular  course  as 
a  matriculate,  and  attended  all  the  lectures. 

In  1852  he  received  the  honorary  decree  of 
Doctor    of  Medicine    from   his  original   a//fia 


*  See  the  American  Cyclopaxli.i :  New  York,  D. 
Appletoii  Ci  Co.,  1875.  Article,  "  Morton,  W.  T.  G.," 
'p. 855.  See  Encyclop;\\lia  Uritannica,  Ninth  Edition, 
.\rticle  "  .\n.vsthesia."  .See  the  Century  lUuslrated 
Monthly  Magazine,  New  York  City,  August,  liS94. 


THE  CANADA  MEDICAL  RECORD. 


87 


miifer,  the  Washington  University  of  Medicine 
(afterwards  merged  inio  the  College  of  Piiysi- 
cians  and  Surgeons),  of  Baltimore,  Md. 

On  September  30,  1846,  at  his  office  in 
Boston,  he  administered  sulphuric  ether  to  Eben 
Frost,  and  extracted  a  tooth  without  pain  to  the 
patient. 

Securing  permission  from  Dr.  John  C.  War- 
ren, Senior  Surgeon  of  the  Massachusetts  Gen- 
eral Hospital,  on  October  16,  1846,  he  adminis- 
tered ether  to  a  patient  at  the  hospital,  and  I  )r. 
Warren  performed  a  severe  surgical  operation, 
the  patient  remaining  unconscious  during  the 
operation. 

He  was  now  twenty-seven  years  of  age  and 
still  a  medical  student  in  the  Harvard  Medical 
School.  The  discovery  now  announced  brouglit 
with  it  overwhelming  labors,  and  he  was  com 
pelled  to  discontinue  his  studies  from  that  mo- 
ment onward. 

From  this  crucial  demonstration  in  October, 
1846,  dates  the  immediate  and  universal  adop- 
tion of  the  practice  of  anaesthesia  throughout 
the  civilized  world.  The  event  marked  the 
advent  of  a  new  epoch  in  the  world's  history, 
namely,  the  epoch  of  practical  painless  sur- 
gery. 

Over  Dr.  Morion's  grave  in  Mount  Auburn 
Cemetery,  near  Boston,  a  monument  has  been 
"erected  by  citizens  of  Boston,"  including 
names  the  most  respected  and  most  honored 
among  them,  bearing  the  following  inscription, 
written  by  the  late  Dr.  Jacob  Bigelow,  of 
Boston  -. 

"  William  T.  G.  Morton, 

inventor  and  revealer  of  an.^sthetic  inhal- 
ATION. 

BY  WHOM  PAIN  IN  SURGERY  WAS  AVERTED 
AND  ANNULLED. 

BEFORE    WHOM,     IN    ALL    TIME,     SURGERY    WAS 

AGONY,  SINCE  WHOM  SCIENCE  HAS  CONTROL 

OF  PAIN." 

A  monument  in  the  Public  Gardens  in  Boston 
is  erected  "  To  commemorate  iXit  discovci-y  that 
the  inhalation  of  ether  causes  insensibility  to 
pain.  First  proved  to  the  world  at  the  Massa- 
chusetts General  Hopital,  in  Boston,  October, 
1846,"  the  date  of  Dr.  Morton's  successful  de- 
monstration at  the  hospital. 

No  other  date  is  upon  this  monument  except 
the  date  of  its  erection,  1867,  and  no  other  refer- 
ence, except  biblical  quotations,  to  anaesthesia. 
It  can  therefore  refer  to  no  one  but  to  Dr. 
Morton. 

Dr.  Morten  received  a  divided  Montyon  prize 
from  the  French  Academy  of  Sciences,  the 
"  Cross  of  the  Order  of  Wasa,  Sweden  and  Nor- 
way," the  "  Cross  of  the  Order  of  St.  Vladimir, 
Russia,"  and  a  silver  box  containing  one  thou- 
sand dollars  from  the  trustees  of  the  Massachu- 


setts General  Hospital,  "in  honor  of  the  ether 
discovery  of  Septemlier  30,  1846."  The  trustees 
in  their  report,  subsequently  reaffirmed,  unanim- 
ously accorded  the  hor.or  and  credit  of  the 
discovery  to  him. 

He  made  several  appeals  for  remuneration, 
for  the  use  of  his  discovery  in  the  army  and 
navy,  to  the  Congress  of  the  United  States  ;  and 
although  committees  to  whom  the  subject  was 
referred  made  majority  reports  that  he  was  en- 
titled "  to  the  merit  of  the  discovery  and  to 
substantial  reward,"  yet  no  reward  was  ever 
voted  to  him.  At  two  sessions  of  Congress, 
bills  in  his  favor  were  passed,  and  on  one  occa- 
sion the  President  of  the  United  States  held  his 
pen  in  his  hand  to  sign  a  bill,  and  paused  to  con- 
sult Jefferson  Davis,  Secretary  of  War,  with 
the  lesult  that  the  bill  was  never  signed. 

Announcing  his  discovery  at  the  age  of 
twenty-seven,  and  dying  at  the  comparatively 
early  age  of  forty-eight,  his  twenty-one  years  of 
adult  and  active  life  were  entirely  consumed 
with  the  turmoil  and  pain  of  the  controversy 
forced  upon  him  by  claims  not  one  of  which 
had  ever  appeared  in  print  until  after  his  initial 
announcement  in  1846. 

He  died  poor,  and  ^'- he  became  poor  in  a 
cause  tvhich  has  made  the  world  his  debtor''' 

THE   TREATMENT   OF   GONORRHCEA 
BY  IRRIGATION  OF  THE  URETHRA. 

By  H.  M.  Christian,  M.D.,  Chief  of  Genito- 
urinary Dispensary,  University  of  Penn- 
sylvania, s-ervice  of  Dr.   Edward  Martin". 

It  is  proposed  in  this  article  to  give  the  re- 
sults obtained  by  the  writer  in  the  treatment 
of  gonorrhoea  by  daily  irrigation  of  the  ure- 
thra. 

A  large  majority  of  the  cases  treated  were 
patients  at  the  Dispensary  for  Genito-Urinary 
Diseases,  University  Hospital ;  a  few  are  taken 
from  the  case-book  in  private  practice. 

The  remedies  used  for  the  purpose  of  irriga- 
tion were  bichloride  of  mercury,  nitrate  of  sil- 
ver, permanganate  of  potassium,  and  trikresol. 
The  irrigator  employed  was  the  ordinary  glass- 
jar  irrigator  used  in  surgical  clinics,  and  was 
suspended  by  a  rope,  working  over  a  pulley,  at 
a  height  of  six  feet  above  the  penis,  the  patient 
standing. 

']'he  Kiefer  nozzle  was  used  in  all  cases,  ex- 
cept in  those  instances  where  it  was  foimd  to 
be  too  large  to  enter  the  meatus  properly ;  in 
such  cases  the  soft-rubber  catheter  was  em- 
ployed. In  irrigating  the  urethra,  one  quart  of 
the  solution — warm,  not  hot — was  used  daily 
for  a  period  of  two  weeks.  In  a  itw  cases 
treatment  was  continued  for  three  weeks  ;  it 
was,  however,  observed  that  no  permanent 
benefit  resulted  from  tliis  extra  week's  treat- 
ment.     In  other  words,   whatever   result  was 


THE  CANADA  MEDICAL  RECORD. 


obtained  from  irrigation  was  always  apparent 
at  the  end  of  two  weeks,  and  no  dictinct  ad- 
vantage was  ever  gained  by  prolonging  the 
daily  irrigation  beyond  that  point. 

Treatment  was  begun  in  all  the  cases  in 
the  first  week  of  the  disease.  Purulent  dis- 
charge from  the  urethra,  ardor  urinse,  and 
chordee  were  present  in  all.  Microscopical 
examination  of  the  discharge  was  made  in 
every  case. 

It  will  be  understood  in  the  statistics  given  i 
below  that  those  cases  in  which  gonococci 
were  found  are  classified  as  infectious  ;  where, 
upon  repeated  examination,  no  gonococci  were 
found,  the  case  is  classified  as  non-infectious 
urethritis. 

1.  Bichloride  of  Mercury. — Strength  of  so- 
lution, I  to  15,000,  increasing  the  second 
week  to  i  to  8000.  Number  of  cases  treated,  ^ 
2C ;  infectious,  19;  non-infectious,  i;  im- 
proved by  treatment, — i.e.,  discharge  becom- 
ing less  in  quantity  and  thinner, — 8;  num- 
ber unimproved,  ri;  cured,  i;  number  in 
which  ardor  urinae  and  chordee  were  lessened 
by  treatment,  18;  number  in  which  ardor 
urinai  and  chordee  were  not  benefited,  2  ; 
number  of  cases  in  which  posterior  urethritis 
developed,  2  ;  number  of  cases  in  which  epi- 
didymitis developed,  o ;  number  of  cases  in 
which  gonococci  were  found  in  discharge  at 
end  of  fourteen  days'  treatment,  19. 

2.  Nitrate  of  Silver. — Strength  of  solu- 
tion, I  to  6000,  increasing  in  second  week  to 
I  to  3000.  Cases  treated,  20 ;  infectious- 
18;  non-infectious,  2;  improved  by  treat, 
ment,  13;  unimproved  by  treatment,  6  ;  cured, 
I  ;  number  in  which  ardor  urinae,  etc.,  les- 
sened, 20  ;  number  in  which  ardor  urinre,  etc., 
unaffected,  o ;  number  developing  posterior 
urethritis,  3  ;  number  developing  epididy- 
mitis, o  ;  number  in  which  gonococci  were 
found  at  end  of  fourteen  days,  16. 

3.  Peruianganate  of  Potassium. — Strength 
of  solution,  I  to  4000,  increasing  in  second 
week  to  i  to  2000.  Cases  treated,  20 ;  infec- 
tious, 16;  non-infectious,  4;  improved  under 
treatment,  10;  unimproved,  3;  cured,  7; 
number  in  which  ardor  urina;,  etc.,  lessened,  19  ; 

'number  in  which  ardor  urin;v,  etc.,  unaffected, 
I  ;  number  developing  i)osterior  urethritis.  2  ; 
number  developing  epididymitis,  i  ;  number 
in  which  gonococci  were  found  at  the  end  of 
fourteen  days,  5. 

4.  Trikrcsol  (Schering). — Strength  of  solu- 
tion, one-half  of  one  percent.  Cases  treated, 
10;  infectious,  10;  non-infectious,  o;  im- 
proved, I  ;  unimproved,  9  ;  cured,  o ;  num- 
ber in  which  ardor  urinse,  etc.,  lessened,  i  ; 
number  in  which  ardor  urinse,  etc.,  unaffected, 
9  ;  number  developing  posterior  urethritis,  o  ; 


number  developing  epididym.itis,  o ;  number 
in  which  gonococci  were  found  at  end  of  four- 
teen days,  10. 

From  a  glance  at  these  statistics  it  will  be 
seen  that,  as  regards  therapeutic  value,  these 
four  remedies  stand  in  the  following  order  : 
first,  permanganate  of  potassium  ;  second,  ni- 
trate of  silver;  third,  bichloride  of  mercury; 
and,  fourth,  trikresol.  By  far  the  most  valu- 
able remedy  in  urethral  irrigation  is  perman- 
ganate of  potassium.  It  is  simply  using  in  a 
new  w-ay  what  has  long  been  known  to  every 
man  about  town  to  be  a  most  potent  drug  in 
the  treatment  of  gonoirhoea.  It  will  be  noted 
that  gonococci  were  found  in  the  discharge  at 
the  end  of  two  weeks'  treatment  in  only  five 
cases. 

Irrigation  of  the  deep  urethra  with  a  i  to 
4000  permanganate  of  potassiuni  solution  is 
the  very  best  method  of  treating  acute  poster- 
ior urethritis,  and  will  result  in  a  cure  in  most 
cases  in  from  about  three  to  five  days. 

Nitrate  of  silver  follows  permanganate  of 
potassium  very  closely,  but  does  not  appear  to 
dry  up  the  discharge  as  quickly  or  as  well. 

In  regard  to  bichloride  of  mercury,  it  was 
evident  that  those  solutions  which  were  strong 
enough  to  have  any  positive  antiseptic  effect 
irritated  the  urethra  and  increased  the  ardor 
urina;.  On  the  other  hand,  the  weaker  solu- 
tions appeared  to  act  very  little  better  than  so 
much  water  on  the  discharge. 

Trikresol  is  a  coal-tar  product  manufactured 
by  Schering,  similar  in  every  way  to  carbolic 
acid.  Solutions  of  the  strength  of  one-half  of 
one  per  cent,  were  found  to  be  very  irritating 
to  the  urethia,  increasing  in  a  marked  degree 
the  ardor  urin.x.  Solutions  of  a  quarter  of 
one  per  cent,  had  little  or  no  effect  ui)on  the 
discharge. 

Seventy  cases  in  all  were  treated  by  irriga- 
tion. Of  these,  seven  were  cases  of  simple 
urethritis.  Thirty-two  were  improved  by  treat- 
ment,— that  is  to  say,  the  condition  at  the  end 
of  two  weeks  was  simply  a  thin  muco-purulent 
discharge  at  meatv.s  in  the  morning  ;  no  ardor 
urinai  or  chordee  or  frequent  and  imperative 
urination ;  further  irrigation  did  not  improve 
this  condition.  These  cases  were  all  cured  in 
about  two  weeks  more  by  use  of  some  astrin- 
gent injection  two  or  three  times  daily. 

In  twenty-nine  cases  the  discharge  was  not 
at  all  affected  by  irrigation.  These  patients 
showed  marked  improvement  in  their  condi- 
tion upon  beginning  the  use  of  a  urethral  in- 
jection containing  bisnuith  and  hydrastis,  and 
the  use  internally  of  a  capsule  containing  san- 
dal wood  oil  and  copaiba. 

Nine  of  the  cases  were  cured  within  the  two 
weeks.      Of  these,    seven  were  cases    of  non- 


THE  CANADA  MEDICAL  RECORD. 


89 


specific  urethritis.  Of  the  nine  cases  cured, 
seven  were  cured  by  permanganate  of  potas- 
sium. Gonococci  were  found  in  small  quan- 
tity in  the  discharge  after  two  weeks'  irrigation 
in  fifty  cases. 

Posterior  urethritis  only  occurred  in  five,  and 
epididymitis  in  one  instance. 

It  should  be  noted  that  in  fifty-eight  cases 
the  ardor  urini^  and  chordee  were  entirely  re- 
lieved by  irrigation  ;  and  of  the  twelve  cases 
in  which  these  symptoms  were  not  affected, 
nine  were  treated  by  trikresol,  a  remedy  which 
was  shown  to  be  very  irritating  to  the  urethra. 

The  results  obtained  in  the  treatment  of 
these  cases  seem  to  warrant  the  following  con- 
clusions being  drawn  : 

1.  That  irrigation  is  a  distinct  advance  in 
the  treatment  of  gonorrhoea  ;  in  fact,  up  to  a 
certain  point,  it  must  be  considered  the  proper 
treatment  for  that  disease.  It  relieves  ardor 
urince  and  chordee  more  promptly  than  any 
other  form  of  treatment.  It  is  attended  with  a 
much  smaller  proportion  of  complications, 
such  as  total  urethritis  and  epididymitis. 

2.  That  permanganate  of  potassium  is  the 
best  remedy  for  the  purpose  of  urethral  irriga- 
tion. 

3.  That  irrigation  of  the  urethra  alone  can- 
not be  relied  upon  to  absolutely  cure  specific 
urethritis. 

For  the  cure  of  the  thin  muco-purulent  dis- 
charge which  appears  at  the  meatus  in  the 
morning,  some  astringent  injection  used  by 
the  patient  himself  is  necessary. 

4.  That  simple  non-infectious  urethritis  can 
be  cured  in  from  ten  to  twelve  days  by  daily 
irrigations  with  permanganate    of   potassium. 

The  writer  is  of  the  opinion  that,  where  it  is 
possible  to  carry  out  the  treatment,  irrigation 
of  the  urethra  with  solutions  of  permanganate 
of  potassium  twice  daily  would  very  materially 
lessen  the  duration  of  the  disease.  This  is,  of 
course,  impracticable  in  dispensary  practice. 
I  am  now  employing  at  the  Dispensary  of  the 
University  Hospital  daily  irrigation  with  per- 
manganate solution,  combined  with  the  inter- 
nal use  of  a  capsule  containing  five  minims 
each  of  oil  of  sandal-wood  and  oil  of  copaiba. 
The  results  obtained  in  these  cases  will  be  pub- 
lished at  another  time.  It  might  be  well  to 
mention  here  that,  for  the  purpose  of  irrigating 
the  urethra  completely,  the  Kiefer  nozzle  is  not 
by  any  means  all  that  could  be  desired.  The 
blunt  nose  of  the  nozzle  will  not  fit  properly 
every  meatus.  On  the  other  hand,  it  is  very 
doubtful  whether  the  urethra  is  irrigated  to 
any  great  extent  by  its  use,  as  it  was  observed 
in  almost  every  case  that  the  irrigating  fluid 
would  make  a  short  circuit  in  the  urethra  from 
the  point  of  entrance  in  the  nozzle  to  the 
point  of  exit. 

The  best  results  were  obtained  from  the  use 
ot  a  soft-rubber  catheter  several  sizes  smaller 


than  the  calibre  of  the  urethra,    allowing  the 
solution  to  escape  easily  along  the  side. 

The  following  table  will  show  at  a  glance  the 
results  obtained  by   urethral  irrigation : 


Drug  employeil. 


1.  Permanganate     of   potassium. 

2.  Nitrate     of    silver 

3.  Bichloride    of   mercury 

4.  Trikresol • 


i 

« 

J 

u 

3 

0 

0. 

s 

,u 

& 

b 

z 

S 

0 
'A 

1 

D 

6 

"ol3  - 


o  z:  u 

O    *^     i* 

O 


i(0 

16 

4 

10 

^ 

7 

20 

18 

2 

13 

6 

I 

20 

10 

I 

8 

1 

I 

10 

10 

0 

I 

9 

0 

THE    TREATMENT  OF  DIABETES 
MELLITUS.* 

By  Solomon  Sous-Cohen,  M.D  ,  of  Philadel- 
phia. 

Throughout  the  management  of  a  case  of 
diabetes  mellitus,  examine  the  urine  at  regular 
intervals,  not  too  far  apart,  and  whenever  its 
acidity  increases,  or  the  sugar  is  suddenly 
diminished  or  absent,  or  the  wine-red  color  is 
developed  by  ferric  chloride,  administer  alkalies 
freely  until  the  urine  is  alkaline  and  the  sugar 
reappears.  Sodium  bicarbonate  may  be  given, 
or,  if  the  quantity  of  urine  is  lessened,  potas- 
sium acetate  or  potassium  citrate,  or  some 
other  diuretic.  Some  authorities,  however, 
caution  against  potassium  salts,  believing  them 
to  be  too  depressing  to  the  heart.  Rochelle 
salt  is  often  useful,  because  it  will  act  either  as 
a  mild  hydragogue  purge  or  as  a  diuretic. 
And  this  leads  me  to  say  that  constipation  is 
often  a  precursor  of  diabetic  coma,  perhaps  a 
cause.  Never  permit  your  patients,  then,  to 
be  constipated.  I  am  in  the  habit  of  giving  to 
diabetic  patients  sodium  phosphate  in  bulk,  and 
directing  them  to  take  one  or  two  teaspoonfuls 
in  hot  water  before  breakfast,  or  perhaps  even 
two  or  three  times  a  day,  the  quantity  and  fre- 
quency to  be  varied  according  to  the  effect 
upon  the  stools.  Bartholow,  indeed,  recom- 
mends sodium  phosphate  as  a  remedy  for  dia- 
betes mellitus,  especially  in  obese  subjects  with 
hepatic  disorder.  Sometimes  he  combines 
with  it  sodium  arsenate,  1-64  grain  to  the 
drachm  of  sodium  phosphate.  This  is  a  useful 
expedient.  Arsenic  is  itself  useful  in  the  treat- 
ment of  diabetes  mellitus.  Lithium  salts  and 
various  alkaline  mineral  waters  are  useful  to 
keep  the  secretions  active  and  neutralize  acid- 
ity. Recently  I  have  been  using  the  salts  01 
strontium,  and  especially  strontium  bromide, 
in  the  treatment  of  lithsemia  and  in  the  treat- 
ment of  diabetes  mellitus  in  the  gouty  and  obese. 
In    doses  of  about  30  grains,  with  20  drops  of 


•Extract  from  a  Clinical  Lecture  in    The  Therapeutic 
Gazette,  May  15,  1894. 


90 


Tim   CANADA   MEDICAL   RECORD. 


glycerin,  and  infusion  of  gentian  to  make  a 
tableppoonful,  three  times  a  day,  before  meals, 
I  have  found  this  drug  of  great  service.  It  is 
a  stomachic  tonic,  promotes  digestion  and  re- 
lieves flatulence,  increases  general  nutrition 
and  quiets  the  nervous  system  ;  at  the  same 
time  it  keeps  the  blood  moderately  alkaline. 
It  can  be  given  for  much  longer  periods  con- 
tinuously than  is  safe  wiih  potassium  salts,  and 
is  not  contra-mdicated  in  liihremic  cases,  as 
most  sodium  salts  are.  Strontium  lactate  is 
likewise  used,  but  I  prefer  the  bromide.  In 
gouty  and  rheumatic  cases  especially,  but  like- 
wise in  hepatic  cases,  sodium  salicylate  is  use- 
ful. It  can  be  alternated  with  strontium  bro- 
mide, and  I  am  in  the  habit  of  giving  it  for  a 
week  or  two  whenever  the  patient  complains  of 
arthritic  or  muscular  pains.  I  prefer  to  give  it 
in  capsule,  followed  by  an  ounce  or  two  of 
water,  the  dose  being  from  5  to  15  grains  three 
times  a  day.  From  time  to  time  strychnine 
arsenate,  j-128  grain  six  times  a  day,  is  given 
as  a  general  nervous  tonic-stimulant. 

.  In  the  case  of  emaciated  patients,  or  in  obese 
patients  temporarily  when  the  sugar  is  exces- 
sive, and  does  not  yield  to  other  measures,  I 
prefer  codeine  to  any  other  drug.  The  dose  is 
from  '^  grain  to  12  grains  or  more  daily.  It 
is  to  be  given  first  in  small  doses,  increased 
until  the  point  of  tolerance  is  reached  or  im- 
provement is  manifest,  and  tlien  decreased  to 
the  smallest  dose  at  which  the  gain  made  can 
be  held.  Following  Sir  B.  W.  Richardson,  I 
give  it  in  solution  with  hydrogen  dioxide,  in 
some  such  mixture  as  this  : — 

Codeine  phosphate,  gr.  ij. 

Alcohol,  f  ^  iv 

Dilute  phosphoric  acid,      f  3  ij 
Glycerin,  f  3  vj 

Solution  of  hydrogen  dioxide 
(10  volume),  enough  to  make  f  5  iij. 
Dose. — 2  teaspoonfuls  in  3  ounces  of  water. 
With  this  an  alkaline  course  is  usually  con- 
joined, the  patient  being  given  some  suitable 
mineral-water.  Arsenic  is  sometimes  added. 
Hydrogen  dioxide,  potassium  permanganate, 
ozonic  ether,  and  oxygen  have  been  advocated 
on  chemical  grounds  in  tiie  treatment  of  dia- 
betes. I  believe  that  any  of  them  would  be 
useful  in  helping  to  avert  threatened  coma,  the 
special  indication,  as  Harley  has  shown,  being 
disappearance  ot  sugar  from  the  urine.  The 
tlieory  is  simply  that  tiiey  bring  about  increased 
oxiuaiion  of  the  sugar  or  secondary  i)roducts 
circulating  in  the  blood.  Hydrogen  dioxide 
water  can  be  given  in  much  larger  doses  than 
I  have  mentioned, — almost  (jd  libituvi,  in  fact, 
— and  oxygen  can  be  conveniently  given  by 
inhalation.  Ozonic  ether  can  be  injected  hypo- 
dermically. 

I  have  not  spoken  of  diet,  taking  that  for 
granted.  It  precedes  medication.  I  will  only 
say  :  Don't  try  to  cut  off  bread  and  potatoes 
altogether;   the  jxilient  won't  submit.     Gluten 


bread   is    not    reliable   and    is    not   palatable. 
Give    small   quantities    of  ordinary    bread, — 
toasted,  if  you    like, — say  six    small    slices  or 
three  rolls  a  day.     An  occasional  roasted  mealy 
potato  will  be  a  great  treat  and  won't  harm  the 
patient.     Beyond  this,  try  to   make  up  by  fats     ■ 
for  the  exclusion  of  starches.     It  is  now  possi- 
ble to  give  our  patients  a  certain  form  of  sugar. 
Last  year  I  had  before  the  diss  a  young,  thin 
man,  then  in  the  hospital,  to  whom  I  was  giv- 
ing levulose,  or  fruit-sugar.     Careful    chemical 
analysis  of  his  urine  by  Dr.  Henry   Leffmann 
showed  that  the  urinary  sugar  did  not  increase, 
but  actually  diminished,  while  the  patient  was 
taking  this  form  of  sugar.     As  you  know,  levu- 
lose, so  called  because  it  rotates  polarized  light 
to  the   left,  has  the  same   empirical  chemical 
formula  as  glucose,  or,  as  the  latter  is  called 
from   its  action  on  polarized   light,  dextrose. 
The  rational  formula  of  the  two  sugars,  how- 
ever, has  been  recently  shown  to  be  different, 
and  the  place  of  levulose  is  among  the  ketone 
group,    while   dextrose   is  placed    among    the 
aldehydes.     This  may  account  for  their  different 
relations     to    the    metabolism     of    diabetics. 
Twenty  years  ago  Kuelz,    of  Marburg,  showed 
that   diabetic    patients   could  assimilate   levu- 
lose  and  inosite,   but   only  recently    has   the 
former  been  produced  as  a  commercial  article. 
I  have  used  it  now  for  nearly  two  years,  and 
in  some  twelve  cases  of  diabetes,  and  in  all  it 
has  been  assimilated.     It  is   sweet, — not  quite 
so    sweet  as  cane-sugar,  but  sweet  enough  to 
enable  our  patients  to  gratify  their  palates, — 
and  it  is  useful  as  a  carbohydrate  aliment.     It 
turns   coffee    somewhat    black.     I    give   it   in 
quantities  of  about  an   ounce  a  day    to   lean 
patients  ;  to   stout  persons  simply  as  a  sweet- 
ening. 

I  am  making  some  observations  now  with 
lactose, — milk-sugar.  Several  patients  have 
taken  as  much  as  4  ounces  of  milk-sugar  in  a 
day  without  increasing  the  excretion  of  sugar 
in  their  urine.  Others  can  take  but  a  fraction 
of  this  quantity.  Philip  is  one  of  the  patients 
on  whom  this  observation  has  been  mide.  He 
can  dispose  of  about  two  ounces  of  lactose 
d.iily, ;  four  ounces  cause  an  increase  of  about 
two  ounces  in  his  daily  dextrose  excretion. 
As  a  practical  deduction  from  these  clinical 
experiments,  I  jicrmit  my  diabetic  patients  to 
drink  milk  freely. 

And  now,  to  conclude,  I  have  three  words  of 
advice  : — 

1.  Keep  your  patients  warm  and  protected  ; 
cold  is  their  greatest  enemy. 

2.  Examine  the  urine  for  organic  acids  and 
keep  the  blood  alkaline. 

3.  In  the  matter  of  diet,  be  strict  enough  to 
diminish  pol)uria  and  glycosuria,  and,  if  pos- 
sible, to  secure  their  disappearance, /)/Y7t////^</ 
you  can  at  the  same  time  keep  the  patient  com- 
fortable ;  but  under  any  circumstances  make 
ihc  palictit  cowforiahlc. 


THE  CANADA  MEDICAL  RECORD. 


91 


THE  NEW  CURE   FOR   DIPHTHERIA, 
CROUP,  ETC. 

If  the  facts  placed  before  the  Hygienic  Con- 
gress held  at  Budapest  last  month  be  not 
overstated,  then  the  whole  world  owes  a  deep 
debt  of  gratitude  to  the  young  French  savant, 
Dr.  Roux,  for  the  patient  and  heroic  researches 
which  have  led  to  the  discovery  of  an  effectual 
cure  for  croup  and  diphtheria,  and  opened  the 
way  for  further  results  not  less  startling.  Such 
is  the  introductory  announcement  in  the  Loii- 
doJi  Daily  Graphic ,  which  also  gives  the  folio w- 

i"g=  .    .       . 

The    distinguished  Dr.    Marsan  points   out 

how  the  new  method  was  established.  Diph- 
theria is  produced  by  microbes  which  plant 
themselves  in  the  membrane  of  the  throat,  and 
multiply  ;  but  unlike  the  bacilli  of  other  infec- 
tious diseases,  they  remain  obstinately  in  the 
same  position,  neither  penetrating  the  system 
nor  the  blood.  But  if  the  deadly  animalcules 
remain  at  the  door,  they  are  still  able  to  secrete 
a  poison  of  extreme  violence,  called  "toxin," 
which  quickly  penetrates  the  circulation  and  in- 
fects the  whole  body.  This  toxin,  thanks  to 
the  achievements  of  science,  can  now  be  isol- 
ated, and  in  the  form  of  a  fine  powder  will  cause 
almost  immediate  death  when  injected  into 
animals.  However,  it  has  been  found  that  if 
a  very  small  dose  be  introduced  into  certain 
animals,  especially  the  horse,  only  a  feeble  re- 
action is  produced.  By  repeating  the  opera- 
tion, with  gradually  increasing  doses,  the  organ- 
ism of  the  animal  finally  revolts,  and  becomes 
not  only  impervious  to  the  toxin,  but  destroys 
it,  and  from  this  singular  result  is  due  the  ori- 
gin of  the  new  substance  with  which  Dr.  Roux 
wages  war  against  diphtheria.  In  a  word,  it  is 
the  basis  of  a  great  revolution  in  the  medical 
world,  which  henceforth  will  recognize  in 
"Serum  therapy"  a  heaven-sent  system  to  root 
out  most  of  the  diseases  connected  with  child- 
hood. As  Dr.  Marsan  well  says,  there  are 
toxins  and  anti-toxins  for  allmicrobic  affections. 
Serum  therapy  will  eventually  discover  a  rem- 
edy for  all  infectious  diseases.  Yesterday  it  was 
tetanus  in  animals  that  it  cured,  to-day  it  is 
diphtheria,  to-morrow  it  will  be  tuberculosis. 

If  you  goto  the  Insiitul  Pasteur,  you  will 
find  comfortably  stalled  in  the  garden  some 
ten  or  a  dozen  cab  horses,  in  prime  condition, 
aged  from  six  to  nine  years,  whose  mission  in 
life  is  to  furnish  the  precious  fluid  which  every 
day  snatches  many  a  young  life  from  an  un- 
timely grave.  They  are  in  their  measure  un- 
consciously solving  the  problem  of  how  to 
sto])  the  depopulation  of  France.  They  are 
well  cared  for,  there  is  no  cruelty  in  the  pro- 
cess, no  suffering  entailed.  The  first  process 
is  to  inject  the  deadly  virus — the  toxin — into 
the  shoulder  of  the  horse.  This,  of  course,  at 
first   causes  ;\  slit^ht  indisposition,  biit  after  a 


while  no  ill  effect  is  felt.  The  second  step,  as 
shown  in  one  of  the  views,  is  to  draw  from  the 
neck  of  the  "pre[)ared"  animal  a  judicious 
quantity  of  blood.  If  the  blood  be  allowed  to 
stand  for  a  while,  the  red  corpuscles  settle  to 
the  bottom,  and  the  operator  can  then  draw  off 
the  fluid,  of  a  yellowish  hue,  resting  above  and 
containing  the  serum,  or  antitoxin.  This,  in 
its  turn,  is  injected  under  the  skin  of  the 
patient  by  means  of  a  syringe  analogous  to  that 
used  for  injecting  morphine. 

On  February  i,  1894,  Dr.  Roux  began  oper- 
ations at  the  Hospital  for  Sick  Children,  Pari?. 
He  had  a  good  supply  of  serum,  and  each  day 
on   making  his  visit  to  the  hospital,  he  treated 
all    the   children  he  found   there,  in  whatever 
state   or    condition    of  croup   or    diphtheria. 
There  was  no  selection  of  subjects,  a  point  to 
be   borne  \\\  mind,  nor  was  the  ordinary  treat- 
ment in  any  way  modified  or  set  aside.  Things 
went  on  exactly  as  they  had  before,  except  that 
a  new  element  had  been  introduced — namely, 
the  serum.     During    1890,    1891,  1892,  1893, 
before  Dr.  Roux  began  his  system,  3,971  chil- 
dren    suffering    from    croup    and   diphtheria 
were  admitted  into  the  Hospital  for  Sick  Chil- 
dren.    Of  these,  2,029  ^^^^  of  the  disease,  the 
mortality    thus  being    52    per  cent.      On    the 
other   hand,  from  February  r    of  this  year  up 
to    July  24,   the   date   up    to  which  Dr.  Roux 
furnished  statistics  to  the  Congress,  the  serum 
was  applied  to  all  without  exception,  and,  out 
of  448  children,  there  were  only  109  deaths — 
that  is,  the  mortality  had  decreased  to  24  per 
cent.     As  the  conditions  during  these  periods 
were  the  same,  the  difference   between  52  per 
cent,  and  24  per  cent,  indicates  the  indisputable 
benefit  derived  from  Dr.  Roux's  treatment.     If 
we  take  the  same  period  at  the  Trousseau  Hos- 
pital, Paris,  where  the  old  methods  prevail,  we 
find  that  out  of  520  children  admitted  there, 
316  died,  thus  giving  a  mortality  of  60  per  cent. 
But  this    is  not  all.     The  serum,  if  applied, 
say,  to  a  child  suffeiing  from  quinsy,  not  only 
puts  that  ailment  to  flight,  but  renders  the  sub- 
ject impervious  to  croup  and  diphtheria  ;  and 
even  measles  and  scarlatina  are  found  to  be  of 
very  rare  occurrence,  and  then    only  of  slight 
character,  when  the  system  has  been  fortified 
by  Dr.  Roux's  wonder  cure.     The  24  per  cent, 
represents  the  saving  of  the  lives  of  120   chil- 
dren  in  six   months   in  one  institution.     The 
gain  would  have    been  more  considerable  but 
for   the  deplorable  hygienic  conditions  of  the 
Hopital  des   Enfants  Malades.     Many   of  the 
deaths,  too,  were  the  result  of  further   compli- 
cations, such  as    heart  disease   and   broncho- 
pneumonia, which  made  the  work  of  the  physi- 
cian very  difticult.     Generally  speaking,  a  sin- 
gle injection  is  sufficient,  and  Dr.    Roux  has 
never  given  more  than  two.     The  dose  consists 
of  two-fifths  of  amount  of  serum    injected  itno 
the   si4e   by  one  puncture,     The  temperature 


92 


THE   CANADA   MEDICAL    RECORD. 


then  decreases,  which  is  an  excellent  beginning.    I 
The  leather-like  membrane  which  is  suffocating   j 
the   little    sufferer  ceases,  within    twenty-four    j 
hours,  to  increase,  and  after  thirty-six  hours  it   i 
comes  away   altogether,  and    the   diphtheritic    ' 
bacilli  disappear.     The  serum  also  has  a  mar- 
velous effect  on  the  appearance  of  the  patient. 
The  dull  and  leaden  complexion,  with  its  accom- 
panying  piteous  cry,  gives  place  to  a  healthy 
skin,  and   the  patient  becomes  cheerful  if  not 

gay- 

REPORTS    ON    NEW  DIPHTHERIA   CURE. 

An  Associated  Press  despatch,  from  Wash- 
ington, D.C.,  dated  Dec.  29,  1894,  says  the 
officials  of  the  United  States  Marine  Hospital 
Service  are  watching  with  interest  the  results 
obtained  from  the  new  diphtheria  cure.  The 
officials  are  already  in  possession  of  consider- 
able information  as  to  the  manner  and  results 
of  applying  anti-toxin  in  Berlin  and  Paris.  At 
the  Children's  Hospital  at  Berlin,  Dr.  Kinyoun 
says  the  larger  proportion  of  cases  suffering 
from  diphtheria  are  treated.  There  were  about 
thirty-five  cases  in  the  hospital  at  the  time  of 
his  visit,  and  their  age  was  usually  3  and  6 
years.  The  death  rate  is  slightly  lower  than  the 
figures  of  the  Paris  hospitals,  for  tlie  reason 
that  in  the  first  place  the  patients  are  sent  to 
the  hospital  sooner,  and  because  the  little  chil- 
dren receive  better  care  than  is  accorded  them 
in  like  institutions  in  Paris.  Dr.  Kinyoun  goes 
into  a  very  elaborate  description  of  the  methods 
employed  in  the  treatment  of  the  disease. 

The  matter  of  the  control  or  supervision  of 
the  use  of  anti-toxin  is  also  engaging  the  atten- 
tion of  the  local  authorities,  and  Dr.  Kinyoun 
reports  that  Nov.  4  Prof.  Koch  convened  a 
meeting  of  the  Prussian  Board  of  Health  for 
determining  what  action  should  be  taken. 
Prof.  Koch  has  expressed  the  opinion  that 
there  should  be  some  government  supervision 
of  the  serum,  so  that  it  could  always  be  relied 
upon.  If  there  was  no  such  supervision,  it 
would  not  be  very  long  before  spurious  articles 
would  be  put  on  the  market,  and  not  only 
would  a  good  remedy  be  brought  into  disrepute, 
,bul  lives  would  be  sacrificed  when  they  might 
be  saved.  It  was  derided  at  the  meeting  of 
the  Board,  that  all  serum  intended  for  use  in 
Prussia  should  be  inspected  and  tested  for  its 
purity  and  strength  before  it  would  be  allowed 
to  be  used.  This  stej)  the  doctor  reports  was 
satisfactory  tc  all  parties  concerned,  and  will  be 
the  means  of  insuring  a  good  article  of  standard 
strength  at  all  times  for  Prussia. 

In  this  connection  Dr.  Kinyoun  calls  atttn- 
tion  to  what  he  says  will  evidently  occur  in  our 
own  country.  Many  persons  will,  durmg  the 
coming  year,  commence  to  prepare  this  serum 
as  a  business  enterprise,  and  there  will  without 
doubt    be  many  worthless  articles  called  anti- 


toxin thrown  upon  the  market.  All  the  serum 
intended  for  sale,  he  believes,  should  be  made 
or  tested  by  competent  persons.  The  testing, 
in  fact,  should  be  done  by  disinterested  parties. 
The  anti-toxine,  he  says,  will  never  work  mira- 
cles ;  it  has  its  liniits.like  any  other  agents,  and, 
like  a  perfect  piece  of  machinery,  will  not  ac- 
complish the  full  result  unless  directed  by  a 
skilled  hand.  "  Some  persons  affected  with 
this  dread  disease  will  succumb,  it  matters  not 
how'  soon  we  apply  the  remedy.  The  majority 
will,  however,  I  am  sure,  recover  if  the  anti- 
toxin is  given  early  and  properly."  .In  closing 
the  report,  expresses  the  hope  that  soon  every 
State  and  mun  cipality  will  lake  the  proper 
steps  to  provide  facilities  for  supplying  the 
])eople.  Incorporated  in  the  report  are  a 
number  of  tables  or  charts  showing  the  effects 
on  the  respiration,  pulse,  and  temperature  .of 
the  administration  of  the  anti-toxin  in  various 
cases.  —  The  National  Popular  Review. 

treatm?:nt  of  renal  disease. 

Dickinson  (  The  Lancet,  February  10,  1894) 
expresses  the  following  views  as  the  treatment 
of  nephritis  : 

Acute  Nephritis . — The  disease  has  a  tenden- 
cy to  recover  spontaneously,  qualified  especially 
in  scarlatinal  nephritis  by  a  tendency  to  fibrosis. 
Warmth  in  bed  and  a  liquid  diet  are  essential 
to  recovery.     The  food  should  be  mild,  animal 
broths  and  a  moderate  amount  of  fi.irinaceous 
food.     Water  and  aqueous    drinks  should  be 
given  freely.    After  a  calomel  purge  it  generally 
sufiices  to  give  a  saline.     Digitalis  is  to  be  given 
only  if  there  is  dropsy,  or  if  the  urine  be  very 
scanty.     Even  though  the  urine  contain  blood, 
no  drug  should  be  given  to  check  the  flow,  as 
it  is  rather  beneficial  than  otherwise.  The  usual 
diuretics  are  useless  and  even  harmfiil,  canthar- 
i   ides  being  especially  harmful. 
1        Chronic  albuminuria   may  continue  almost 
j    indefinitely  without  much  apparent  injury  to  the 
I   patient.     The    heart   will   hypertrophy    as    a 
I    salutary    adjustment,  and  the  dropsy  may    be 
indefinitely   postponed.     In   a  quiescent  case, 
j    temperance  in  diet  is  much  to  be  preferred  to 
I   austerity.    Farinaceous  and  vegetable  food  may 
be   allowed  without    restriction,  milk  in  abun- 
dance, watery  drinks  freely,  and  the  less  alcohol 
the  better.   A  purely  milk  diet  is  advantageous. 
When  urine  is  scant  and  of   low  gravity,  large 
amounts  of  liquid  should  be  taken.     It  is  often 
necessary  to  save  life.      In  movable  cases  it  is 
well  10  have  the  patient  in  a  warm  climate  with 
a  low  relative  humidity.     So  far  as  medicines 
are  concerned,  it  is  a  good  practice    to  give  a 
ferruginous  laxative  combined  with  a  small  dose 
of  strychnine.     The  normal  termination  of   the 
granular  kidney  is  by //;'fij////<7.  Sweating  should 
be  enforced  where  the  uraemia  is  indicated  by 
headache,  vomiting,  etc.  A  Turkish  bath  every 


THE  CANADA  MEDICAL  RECORD. 


93 


ten  days  may  long  ward  off  what  would  other- 
wise happen,  or  a  hot-air  bath  by  a  lamp  under 
sheet  may  be  used.  If  the  patient  be  weak,  it 
is  much  better  to  give  a  partial  hot-air  bath  than 
to  envelop  the  wliole  body.  The  L'gs  may  be 
alone  enveloped  in  the  sheet,  and  this  will  be 
valuable  in  many  instances. 

Treatment  of  the  Dropsy. — Nature's  cure  is 
hypertrophy  of  the  heart.  Measures  which 
lessen  the  contents  of  the  vessel  and  increase 
the  force  of  the  heart  are  indicated.  Digitalis 
is  almost  invariably  indicated.  Most  diuretics 
are  useless  ;  some  are  harmful,  as  cantharides. 
Vegetable  salts  of  potash  may  be  used.  Hy- 
dragogue  purgatives  have  their  use.  The 
abdomen  may  be  tapped  when  there  is  excessive 
ascites,  but  the  legs  must  never  be  tapped. 
Renal  asthma  admits  of  relief  with  alcohols, 
ethers,  and  amyl  nitrite. 

SOME  NEW  ANIMAL  EXTRACTS. 

I  am  a  full  believer  in  the  virtue  of  animal 
extracts,  and  have  been  making  some  experi- 
ments on  my  own  hook.  1  am  fully  persuaded 
in  the  efficacy  of  brains,  as  a  cure  for  dudes 
and  other  functional  cerebral  troubles.  The 
cortex  is  of  especial  value.  In  assumed 
blindness  the  chopped  up  cuneate  lobes  I 
have  found  of  value  especially  in  hemianopsia 
— indeed,  it  is  only  second  to  gold  in  rendering 
a  judge  capable  of  seeing  the  right  side  of  the 
question. 

If  the  minced  organs  are  good  for  the  mala- 
dies of  the  corresponding  parts  of  men,  why, 
then,  the  stronger  the  organ  the  better  the 
remedy ;  and  if  what  is  true  of  the  parts 
must  mathematically  be  true  of  the 
whole,  why,  then,  the  chief  characteristic  of  the 
entire  organism  ought  to  be  extracted  and 
capable  of  imparting  its  peculiar  nature  as 
desired  by  hyp;  dermic  injecti'on. 

One  of  my  friends  had  a  pet  ostrich,  which 
kept  his  yard  free  from  tin  cans,  cobble  stones, 
ancient  shoes  and  such  like  debris.  Often 
had  I,  when  confronted  with  Samson  hash  or 
Sandowe  butter,  wished  I  had  the  stomach  of 
that  ostrich.  Acting  on  that  suggestion,  I 
bought  the  bird  and  proceeded  to  make  the 
exiract.  I  pounded  him  two  hours  with  a 
pile-driver,  macerated  him  one  week  in  aqua- 
fortis, triturated  him  with  dynamite,  boiled  him 
down,  ard  then  carefully  filtrated  nnd  sterilized 
his  remains.  Before  trying  this  mixture  on  a 
human  being,  I  tested  it  physiologically.  I 
found  it  digestvd  a  bride's  first  biscuit  in  five 
minutes  ;  an  antiquated  spring  cliicken  gave 
u])  the  struggle  in  12  minutes  and  42  seconds. 

I  made  a  thorough  aseptic  ten  per  cent, 
s  )lution,  and  injected  it  into  a  dyspeptic  dude 
whose  chief  sustenance  had  been  tooth-j^ick 
broth  and  cigarette  puffs,  at  11  a.m.  At  3  p.m. 
I  was  hastily  summoned  by  telephone  to  see 
my  patient,  who  had  eaten  one  dozen  hard 
boiled  eggs,  a  jilate  of  sinkers,  and  had  begun 
on  the  head  of  his  cane.     I    think  a  proper 


dilution  of  ostrichine  will  prove  invaluable  for 
dyspepsia.  I  have  sold  the  right  to  put  up 
ostrichine  to  Rustle  &  Co.,  of  Gotham.  I  have 
learned  that  since  then  another  firm  has  put 
up  an  ostrichin-^,  but  I  wish  to  inform  the 
medical  public  that  the  real,  true,  and  only 
original  ostrichine  is  put  up  by  Rustle  &  Co. 
Beware  of  substitution  ;  none  genuine  without 
the    final  e. 

A  neiglibor  of  mine  had  a  bull  pup,  who  was 
b'essed  with  a  large  bump  of  adhesiveness. 
Indeed  he  had  been  known  to  adhere  so  close- 
ly to  a  pair  of  pantaloons  encasing  a  young  man, 
that  he  was  only  removed  by  an  amputation. 
It  occurred  to  me  what  a  fine  thing  it  would  be 
to  change  this  pertinacity  in  a  good  cause,  so  I 
purchased  the  dog,  pulverized  him,  and  made 
a  strong  limbei'gery  mixture — dog-gone  strong 
my  assistant  said,  and  awaited  a  suitable 
opportunity  to  use  it.  I  had  on  my  list  an  ex- 
Keeleyite,  who  was  a  victim  of  mania-circulaire- 
whiskeyi-tvvice-a-week-abus.  After  the  second 
injection  he  was  able  to  pass  through  the 
VII Ith  ward  all  hours  of  the  day  or  night  with- 
out cracking  a  "  smile."  I  tried  it  on  a  mug- 
wump, with  the  result  that  he  voted  the  party 
ticket  straigiit,  although  it  was  headed  by  a 
yellow  dog  of  the  most  pronounced  type. 
Bullpupine  will  be  in  great  demand  this  fall, 
and  I  propose  to  put  it  on  the  market  in  blocks 
of  five  about  election  time. 

I  was  not  always  so  successful  in  my  experi- 
ments. P'rom  cows'  teeth  I  made  a  powder 
which  was  fine  for  tooth-ache  on  the  lower  jaw, 
but  was  not  worth  a  continental  red  for  trouble 
in  the  upper.  I  am  now  looking  for  a  cow  that 
has  not  lost  her  upper  front  teeth  ;  when  I  find 
her,  I  can  manufiicture  a  dead-open-and-shut 
cure  for  the  toothache  every  time. 

This  ])rinciple  is  capable  of  almost  indefinite 
elaboration.  I  have  some  foxine  for  detectives, 
dovine  for  your  best  girl,  and  am  now  at  work 
on  horses,  hoping  I  may  extract  some  "  horse 
sense  "  for  strikers.  Some  owline  for  states- 
men who  must  stay  out  all  night  comes  high, 
but  must  be  had.  I  have  received  several 
orders  from  Kentucky. 

I  have  made  a  greater  invention  than  Mid- 
shipman Easy's  father,  who  contrived  a  machine 
which  was  to  compress  the  bumps  and  to  suck 
out  the  hollows  on  a  person's  head  until  the 
head  I'eached  the  height  of  phrenological  pei-- 
fection.  Now  medical  science  will  enable  us 
to  inject  into  the  system  missing  qualities,  or 
supply  the  proper  antidotes  to  any  overbalanc- 
ing propensities.  This  will  be  true  not  only 
ofpeimanent  but  temporary  conditions,  and 
the  doctor  of  the  future  will  carry  concentrated 
mora  ity  in  his  hypodermic  case,  just  as  now 
he  does  morphine  and  strychnine.  .When  he 
comes  home  late  he  will  take  a  dose  of  dovine 
that  will  enable  him  to  complacently  listen  to 
wifely  admonitions,  I  hope  that  I  may  find  many 
and  valuable  uses  for  the  animal  extracts. — 
Southern  California  Practitioner,      H.A.W, 


94 


THE   CANADA.   MEDICAL    RECORD. 


THE  CANADA  MEDICAL  RECORD 

Published  Monthly. 


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EDITORS : 

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London 
F.  WAYLAND  CAMPBELL,  MA,  M.D.,  LRCP  .  Londou 

ASSISTANT  EDITOR 
HOLLO  CAMPBELL,  CM-,  M.D- 

Make  all  Cheques  or  P.O.  Money  Orders  for  subseriiitioii  or 
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exchanges  should  be  addressed  to  the  Editor,  Dr.  Lapthorn 
Smith.  248  Bishop  Street. 

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Editor. 


MONTREAL,  JANUAKY,  1895. 


REMOVAL  OF  THE  UTERUS  BY  ENU- 
CLEATION WriHOUT  CLAMP  OR 
LIGATURE. 

For  the  reintroduction  of  this  remarkable 
operation  we  are  indebted  to  Dr.  Pratt  of  Chi- 
cago, who  deserves  all  the  more  credit  for  his 
persistent  efforts  to  bring  it  into  notice,  because 
he  performed  the  operation  a  great  many  times 
before  succeeding  in  inducing  other  operators 
to  give  it  a  trial.  Indeed,  most  gyngecologists 
were  doubtful  as  to  the  possibility  of  such  an 
operation  being  ])erformed  as  that  of  removing 
the  uterus  by  the  vagina  without  the  use  of 
clamps  or  ligatures.  Recently  Dr.  Goffe  of 
New  York  has  reported  a  successful  case,  and 
before  long  the  operation  will  probably  become 
the  accepted  one.  It  has  the  great  merit  of 
not  injuring  the  great  uterine  branches  of  the 
sympathetic  nerve,  the  inclusion  of  which  in  the 
ligaturts  or  clamps  in  the  old  method  is  said  to 
*'be  the  cause  of  the  lefle.x  disturbances  from  \vhi(  h 
such  patients  suffer  for  a  long  lime.  The  secret  of 
performing  this  apparently  wonderful  operation 
lies  in  keeping  close  to  th.c  uterus  all  the  time, 
and  to  use  a  spud  or  dull  instrument  for  push- 
ing off  the  rich  vascular  network  which  sur- 
rounds the  uterus.  If  this  layer  of  blood  vessels 
be  cut,  a  ligature  must  be  a|)plicd  ;  but  Pratt 
claims  that  he  can  remove  the  uterus  in  every 
case  without  losing  an  ounce  of  blood.  Thesuc- 
ctss  of  tlie  operation  shows  that  we  should  not 
doubt  an  asserii  )n  because  we  do  not  understand 
it,     'I'lu-  improb.ible  i,s  constanllv  happening. 


BOOK  REVIEWS. 

From  reading  an  editorial  in  our  esteemed 
contemporary  i\\t  Journal  of  the  American  Me- 
dical Association, — a  journal,  by  the  way,  which 
does  credit  to  this  continent, — it  would  appear 
that  some  editors  ignore  or  speak  ill  of  a  good 
book  because  it  is  from  the  press  of  a  rival  pub- 
lisher. We  could  hardly  believe  that  a  medical 
editor  could  so  far  forget  the  duty  he  owes  to 
his  readers  to  allow  himself  to  be  influenced  by 
any  consideration  except  the  merits  of  the  work 
under  review.  For  our  own  part,  we  feel  unable 
to  criticize  the  majority  of  the  excellent  books 
which  are  from  tiaie  to  time  noticed  in  our  col- 
umns, and  we  only  attempt  to  keep  our  readers 
informed  as  to  what  books  have  lately  appeared, 
and  as  far  as  possible  to  give  them  some  idea 
as  to  their  contents.  The  interests  of  our 
readers  are  the  first  and  only  ones  which  we 
consider  in  our  Review  department. 


BOOK  NOTICES. 

Philadelphia,  Dec.  7,  1894. 
Editor  Canada  Medical  R&cord, 
Dear  Doctor  : — 

I  have  learned  that  7 he  Index  Mediciis  will 
cease  to  be  published  with  the  February  num- 
ber, owing  to  lack  of  support  and  the  fact  that 
a  large  number  of  its  subscribers  are  delinquent, 
unltss  an  effort  is  made  to  continue  it. 

The  value  of  this  publication  to  tliose  who 
do  any  work  at  all  in  connection  with  medical 
literature  is  so  great,  that  I  take  the  liberty  of 
writing  to  you,  to  express  the  hope  that  you 
will  not  only  become  a  subscriber,  but  will  urge 
other  of  your  professional  friends  to  do  so. 

It  is  particularly  necessary  that  The  Index 
Med  cits  should  be  continued,  owing  to  the  fact 
that  after  the  completion  of  the  supplementary 
volume  of  The  Index  Catalogue  of  the  Surgeon 
General's  Library  there  will  be  no  record  of 
contemporary  medical  literature,  and  he  who 
desires  to  keep  pace  with  it,  or  who  wishes  to 
study  a  particular  subject,  will  have  to  resort  to 
the  laborious  task  of  seeking  in  various  journals 
that  which  he  desires  if  the  publication  of  The 
Index  Medic  us  ceases. 

It  will  be  possible  to  continue  7 he  Index 
Medicus  if  500  ne.v  subsrribeis  are  obtained. 
The  subscription  price  is  $10  per  annum,  which 
should  be  sent  to  Mr.  (ieorge  S.  Davis,  pub- 
lisher of  The  Index  Medicus,  Box  47c,  Detroit, 
Michig;in. 

As  the  Index  MedUus  can  never  be  made  c\ 


THE  CANADA  MEDICAL  RECORD. 


95 


success  from  a  commercial  point  of  view  be- 
cause of  tlie  peculiar  scope  of  its  work,  I  have 
no  liesitancy  in  making  you  acquainted  vvitli 
these  facts,  and  I  earnestly  hope  that  you  will 
insert  a  notice  empliasizing  the  importance  of 
this  matter  in  the  columns  of  your  valuable 
journal. 

Yours  truly, 

H.  A.  HARE. 

Cazeaux    and   Tarnier.       The  Theory   and 
Practice  of  Obstetrics,  including  Diseases 
of  Pregnancy  and  Parturition,   Obstetrical 
Operations,  etc.,  by  P.  Cazeaux,  remodelled 
and    rearranged  with  additions  and  revi- 
sions by  T. Tarnier,  Professor  of  Obstetrics 
and    iiiseases   of  Women   and    Children 
in  the  Faculty  of  Medicine  of  Paris.     The 
Eighth  American  edition,  edited  and  revis- 
ed by  Robert  J.    Hess,    M.D.,   Physician 
to  the  Northern  Dispensary,  Philadelphia, 
with  an  appendix  by  Paul  F.  Munde,  M.D  , 
Professor  of  Gynaecology  at  the  New  York 
Polyclinic  and  at  Dartmouth  College;  Vice- 
President  American  Gynaecological  Society, 
with    chromo-lilhograph,    lithograph    ai;d 
other    full-page  plates  and    one   hundred 
and  seventy-five  wood  engravings.    Phila- 
delphia :  P.  Blakiston,  Son    &    Co.,   1012 
Walnut  street,  1893. 
This  work  will  always   remain  an  inexhaust- 
ible mine  of  information,  and  we  rejoice  to  see 
it  once  more  accessible  to  the  profession  in  a 
new  and  attractive  dress.     It    is  a  work  of  re- 
ference  which    should  find  a  place  in    every 
library. 

A  Text-Book  of  Pathology,  Systematic  and 
Practical,  by  D.  J.  Hamilton,  M.B  ,  F.R.C. 
S.E.,    F.R.S.E.,    Professor   of  Pathology, 
University  of  Aberdeen.     Copiously  illus- 
trated.   Vol.   n,  Part  I,  pages   i   to  514; 
Vol.  n,  Part  n,  pages  515  to  end.     Lon- 
don :  MacMillan  &  Co.,    and    New  York, 
1894.     For   sale   by  the  Copp  Clark  Co., 
Ltd.,   publishers,   9  Front  Street  W.,  Tor- 
onto. 
This   is  beyond  question  the  most  complete 
work   of  Pathology  in  the  English  language  to- 
day.    The   author  has  accomplished  his  labor- 
ious task  most  successfully.   We  have  searched 
in  vain   for  some  question  in  Pathology  which 
the   author   has  not  noticed  ;  we  cannot  better 
criticize  it  than  by  saying  that  it  is  beyond  criti- 
cism.       Modern    bacteriology,  including    the 
staining  and  mounting  of  bacilli,  is  so  explicitly 
dealt    with,   that   no  diliiculty   need  be  expe- 
rienced in  the  general  practitioner's  preparing 
his  own  specimens.     There  are  no  less  than  700 
beautiful  illustrations  in  the  two  volumes  before 
us,  and  thousands  of  references  to  journal  arti- 
cles and  lectures.    The  get-up  of  the  book  is  in 
McMillan's   faultless  style.      We    bespeak  for 
the    work  a  large  sale  in  Canada. 


Notes  on  the  Newer  Remedies,  their  Ther- 
apeutic Applications  and  Modes  of  Ad- 
minis  i  ration.      By  David  Cerna,  M.D., 
Ph.D.,    Demonstrator  of  Physiology,  and 
Lecturer  on  the  History  of  Medicine  in  the 
Medical    Department  of  the  University  of 
Texas.     Second  edition,  enlarged   and  re- 
vised.   Philadelphia  :  W.  B.  Saunders,  925 
Walnut  street,  1895.     Price,  $1.25. 
This  is  a  handy  little  volume  of  250  pages, 
very   complete   for  its  size.     We  have  glanced 
over  it,  and  found  a  brief  but  very  good  account 
of  many   drugs  which   are  not  to  be  found  in 
some  of    tlie   larger  works.     It  is   thoroughly 
up  to  date,  and  has  a  remarkably  good  index, 
rendering-  i'  useful  both  to  students  and  busy 
practitioners.    It  may  be  obtained  through  any 
bookseller. 

Physiology   for  Beginners.     Bv  M.  Foster, 
M.A.,  M.D.,  F.R.S.,  Professor  of  Physiol- 
ogy in  the  University  of  Cambridge  ;  and 
Lewis  E.  Shore,  M.A.,  M.D.,    Senior  De- 
monstrator of  Physiology  in  the  University 
of  Cambridge.    London  :  McMillan  &  Co., 
and  New  York,  1894;  or  the  Copp  Clark 
Co.,  publishers,    9  Front  street   W.,  Tor- 
onto.   Price,  $1.00. 
This  is  a  beautiful  little  work,  clearly  written 
and  printed  on  good  paper,   and  nicely  bound. 
It  is  similar  to  Huxley's  Elementary  Physiology, 
but    differs  from  the  latter  in  that  it  is  written 
for  those  who  have   no  previous  knowledge  of 
the  subject.     It  is  fairly  well  illustrated,  but 
the    author  insists    upon   the  necessity  of  the 
reader  seeing  the  things  for  himself  either  with 
the   eye  or  by  the  aid  of  a  microscope.     He 
says  a  serviceable  microscope  can  be  obtained 
for  $15.     It  is  just  such   a  one   as   might  be 
used  for  school  children  with  the  greatest  bene- 
fit. 

Syllabus  of    Gynecology.       Based  on    the 
American  Text-Book  of  Gynaecology,  by 
G.  W.   Long,  M.D.,  Richmond,  Professor 
of  Gynecology  in  the  Medical  College  of 
Virginia,  etc.    Philadelphia  :    W.  B.  Saun- 
ders, Walnut  street,  1895.  Price,  $t.oo. 
This  book,  which  is  of  a  convenient  size  for 
carrying   in   the  pocket,  is  after  the  same  plan 
as  Senn's  Syllabus  of  Surgery.    It  has  been  writ- 
ten  with  g,   threefold    object :  first,  to  be  used 
as  lecture  notes  ;  secondly,  to  enable  the  stu- 
dent more  intelligently    to  follow  and  remem- 
ber the  lectures;   and  finally,  as  a  convenient 
reference  for  practitioners.     In  either  of  these 
capacities  the  book  will  be  found  to  be  valuable. 
As  a  note-book  for  the  teacher,  it  would  render 
the  task  of  lecturing  an  easy  one,  for  if  he  only 
spoke  for  a  few  minutes  on  each  note  he  would 
deliver  a   very   complete   course   of  lectures. 
Being  interleaved,  the  professor  can  introduce 
the  notes  of  illustrated  cases  or  any  other  mat- 
ter on  which  he  desired  to  lay  particular  stress. 
To   both   student   and  professor  it  will  save  a 
great  deal  of  time  and  trouble. 


96 


THE  CANADA  MEDICAL  RECORD. 


Laboratory  guide  for  the  Bacteriologist. 
By  Langdon  F"roihingham,  M.D.V.,  Assis- 
tant   Demonstrator    of   Bacteriology  and 
Veterinary    Science,     Sheffield    Scientific 
School,     Vale      University.       Illustrated. 
Philadelpliia  :  ^V.  B.  Saunders,  925  Walnut 
street,  1895.     Price,  75  cents. 
It   is   not  otien  that  we  say  of  a  book  that  it 
fills  a  iong-felt  want ;  but  in  the  case  of  the  work 
before  us  we  can  say  it  truly.    By  following  the 
plain  directions  given  in  this  work,  the  mysteries 
of  preparing,   mounting  and  staining  pathologi- 
cal specimens   are  laid  bare,  and   any  practi- 
tioner  can  make  his  own  diagnosis  of  cancer, 
diphtheria,  tubercle,  etc.,  with  very  little  loss  of 
time.     Full   and   clear   directions    for  making 
staining  solutions    are  also  given,  so  that  work 
with  the    microscope   becomes  comparatively 
easy.    In  our  opinion,  this  is  just  the  book  that 
hundreds  of   earnest  thorough   physicians  have 
been  waiting   for,  and  we  predict  for  it  a  large 
sale. 


CYSTITIS  AND  METRITIS. 

\V.  Warwick,  M.D.,  King's  College,  Aberdeen, 
M.H.C.S.,  England,  1851,  L.  M.  Roy.  College,  Belfast, 
1849,  etc.,  Belfast,  Ireland,  says  :  '•  I  have  given  ^a«- 
vietto  a  very  good  tiial  in  cystitis  and  metritis,  and  the 
results  have  been  most, satisfactory.  I  do  not  know 
another  remedy  which  I  can  rely  on  for  such  uniform 
good  results  in  aflfections  of  the  genito-urinary  organs," 


PAMPHLETS. 

Immediate  Capsulotomy  Following  the  Re- 
moval OF  Cataract.  By  L.Webster  Fox, 
M.D.,  Professor  of  Ophthalmology  in  the 
Medico-Chirurgical  College  of  Philadel- 
phia. Extract  of  a  paper  read  before  the 
Stale  Medical  Society  of  Pennsylvania, 
May  17,  1894. 

Evisceration  of  the  Eye-Ball.  By  L.  Web- 
ster Fox,  M.D.,  Professor  of  Ophthalmo- 
logy, Medico-Chirurgical  College,  Phila- 
delphia, Pa.  Reprinted  from  the  Codex 
Medicns  Philadelphue,  November,  1894. 
Philadelphia  :  Press  oi  A,  Van  Home,  119 
North  Sixth  Street,  1894. 

An  Introductory  Address  to  the  Students 
OF  the  Medico-Chirurgical  College. 
By  L.  Webster  Fox,  M.D.,  Professor  of 
Ojjhthalmology  in  the  Medico-Chirurgical 
College.     Delivered  October  3,  1894. 


PUBLISHERS  DEPARTMENT. 

SANME'lTO  IN  DISEASES  OF  THE  BLADDER 
AND  KIDNEY. 

To  whom  it  may  concern:  I  have  been  in  the  prac- 
tice of  medicine  for  the  past  foriyfour  years,  and  say 
without  hesitation  ihat  I  have  never  prescrilied  any 
remedy  thai  in  its  action  is  so  near  a  specific  in  diseases 
of  the  bladder  and  kidney  as  Saninetto,  and  |iaiticularly 
in  cases  of  urelliral  inflammation  combined  with  ditVicult 
miciunlion.  Much  might  be  said  truthfully  in  favor  of 
SaniiHtlo  in  all  diseases  of  the  gemto  urinary  organs.  I 
think  it  is  the  remedy  for  those  diseases,  and  the  bes>t 
now  in  use. 

D.  Calkins,  M.D. 
East  Lyme,  Conn. 


LATE  LITERARY  NEWS. 

An  old-fashiontd  sea  story  full  of  interest  and  adven- 
ture, with  a  strong  love  motive,  is  begun  by  \V.  Clark 
Russell  in  the  January  Cosmopolitan.  "  Ouida  "  succeeds 
Froude,  Gosse,  Lang,  ar.d  other  distinguished  writers, 
with  an  instalment  of  the  "Great  Passions  of  History  " 
series,  which  has  been  appearing  in  the  Cosviopolilan. 
A  discussion  is  aroused  by  Mr.  Edward  Bok's  article  on 
"  The  Young  Man  and  'Ihe  Church,"  which  wil!  con- 
sume tons  of  ink  before  it  is  settled.  Just  precedmg  the 
famous  Charcot's  death  he  prepared  an  article  for  the 
CosDiopoiitan  on  Pasteur,  to  \k  published  after  Pasteur's 
death.  But  Charcot  has  died  first,  and  so  with  the  con- 
sent of  Charcot's  executors,  the  article  is  given  now. 
The  present  "'Ihealrical  Season  in  New  York"  is  cri- 
tically considered  by  Mr.  James  S.  Metcalfe,  editor 
of  Life,  and  there  are  stories  by  Toarg^e,  Howells, 
and  the  famous  French  writer  Fran5ois  Coppee. 


LITERARY  NOTES. 

From  The  Ladies'  Home  Journal,  Philadelphia. 

DR.   PARKHURST   AND   WOMEN. 

Dr.  Parkhurst  has  entered  into  a  contract  with  7 he 
Ladies'  Home  Journal,  by  which  he  will  practically  be- 
come a  regular  editorial  contributor  to  that  magazine  for 
sometime.  The  great  New  York  preacher  says  that  he 
has  for  a  long  time  past  lieen  desirous  of  saying  some 
very  necessary  things  to  women,  and  he  now  announces 
that  he  will  say  them  through  these  articles.  He  will 
take  up  all  the  social,  moral  and  equality  questions 
which  are  so  uppermost  in  the  minds  of  women  to-day. 
Dr.  Parkhurst  will  begin  this  work  at  once,  his  first  art- 
icle appearing  in  the  next  issue  of  the  Journal. 


Edward  Bellamy,  the  author  of  "  Looking  Back- 
ward," is  to  tell  in  the  ne.xt  issue  of  T he  Ladies'  Home 
Journal  what  he  believes  a  *•  Christmas  in  the  Year 
2000"  will  be  like. 


At  .this  season  of  the  year,  when  radical  and  sudden 
thermal  changes  are  the  rule,  it  becomes  of  vital  interest 
to  the  busy  practitioner  to  have  in  compact,  ready  form, 
such  approved  medicaments  as  meet  the  analgesic  and 
antithermic  rei[uirements  of  the  bulk  of  his  patients.  As 
pertinent  we  call  attention  to  the  following  comljination 
tablets:  "Antikamnia  and  Codeine,"  each  containing 
4J  gr.  antikamnia  and  %  gr.  codeine;  "Antikamnia 
and  Quinine,"  each  containing  2i  gr.  antikamnia  and  2h 
gr.  ([uinine  ;  "Antikamnia  and  Salol,"  eacli  containing 
2.1  gr.  antikamnia  and  21  gr.  salol ;  and  "  Antikamnia, 
Quinine  antl  Salol,"  each  coniaining  2  gr.  antik.imnia, 
2  gr.  (luinine  and  i  gr.  salol.  Tiicse,  together  with  the 
well-known  "  Antikamnia  Tablets,"  of  varied  sizes, 
anil  *'  Antikamnia  Powdered,'"  constitute  indispensable 
factors  in  the  aimamentarium  of  t|je  physician,  and  are 
more  than  onlinarily  indicated  in  present  climatic  cone 
dilions. 


m 


WM 


^.t> 


Vol.  XXIII, 


MONTREA.L,  FEBRUARY,  1895. 


No.  5. 


ORIGINAL  COMMUNICATIONS. 

Recent  Electro-  Therapeusis  of  Goi- 
tre with  iinproveiuents  in  Ap- 
l)aratus 97 

SOCIETY  PROCEEDINGS. 

JMoiitreal  Medico-Cliirurgical  Soci- 
ety     90 

Primary  Carciuoma  of  tlie  Kidney..  100 
Multilocular  Cyst  of  the  Right  Ovary  100 

Tubal  Pregnancy  101 

Hematoma  of  tlie  left  Ovary— Chro- 
nic Salpingitis '. 101 

Embryo  in  Sac 101 

Diaphragmatic  Hernia  101 

Pus  Tubes  and  Hiematoma  in  the 
same  patient.  Pus  Tubes  removed 
during  an  Acute  Attack  of  Perito- 
nitis. Double  Hydrosalpinx,  caus- 
ing Severe  Dysmenorrhcea. 101 

Primary  Carcinoma  of  the  Kidney. .  103 

Pathological  Report  104 

Secondary  Enchondroma  in  a  Bitch.  105 
Primary  Laryngeal  Tuberculosis  Ac- 
quired by  Cohabitation 106 

Results  of  Castration  upon  the  Fe- 
male Voice 106 

Intubation  of  the  Larynx 106 

Treatment  of  Epistaxis 106 

Enlargement  of  the  Prostate 106 


Some     Ijifrequent     Symptoms      of 

Disease  of  the  Urinary  Tract 107 

Operative  Treatment  of  Gastric  and 
Typhoid  Ulcers    Associated   with 

Perforation 107 

Treatment  of  Certain  Symptoms  of 
Croupous  Pneumonia,  particularly 

in  Adults  '.  109 

Sewer    Gas  as  a    cause    of    Throat 

Disease 110 

FoUicular'Tonsillitis - no 

Hiemorrhoids 110 

Lemonade  for  Diabetics  110 

Local  Ana'stlu'tic  Solution 110 

Lubrication  or  (Jatheters 110 

Malakiiie  in  Itheuniatisni 110 

PROGRESS  OF  SCIENCE. 

Torsion  rd'  Arteries  for  the  Arrest  of 

Hemorrhage 110 

A  Xew  Treatment  for  Hydrocele. ...  Ill 
Freedom  from    Recurring    Appen- 
dicitis after  Evacuation  of  the  Ab- 
scess^and  Retention  of  the  Appen- 
dix   Ill 

Boric-Acid  Injections  in  Gonorrhoja.  113 
The  Extinction  of  Tuberculosis .  ...  113 
Castration  in  Hypertrophy    of  the 

Prostate  Gland 113 

Cancer  Houses  and  their  Victims....  114 


EDITORIAL. 

The  Anti-Toxin  Treatment  of  Diph- 

tlieria us 

Should  Phthisis  be  Stamped  Out?.  .  115 

The  Tyiihoid  ( lyster  Scare 110 

The  Practitioner  of  St.  Louis 117 

The  Canadian  :Medical  Review 117 

Canadian  Medical  Association 118 

Acknowledgment lis 

BOOK  NOTICES. 

On  Preservation  of  Health  in  India.  118 

Surgical  Pathology  and  Therapeu- 
tics     ...  118 

Transactions  of  the  College  of  Phy- 
sici.ans  of  Philadelphia  118 

A  Practical  Theory  and  Treatment 
of  Pulmonary  Tuberculosis 119 

Pamphlets  received no 

Publishers  Department 120 

Malign  Tumors  of  the  Kidney 120 


^n^fnal    Communications. 

RECENT    ELECTRO-THERAPEU- 
SIS   OF   GOITRE,  WITH  IMPROVE- 
MENTS   IN  APPARATUS. 

By  Dr.  Charles  R.  Dickson,  Toronto, 
Electro-Therapist  to  Toronto  General 
Hospital,  Hospital  for  Sick  Children, 
St.  JoJuis  Hospital  and  St.  Michael's 
Hospital. 

[Abstract  of  paper  read  before  annual  meeting  of 
American  Electro-Therapeutic  Association,  in  New  York, 
September,  1894.] 

About  five  years  ago  I  formed  the  opin- 
ion, that  for  the  treatment  of  goitre  we  had 
at  our  disposal  an  agent  which,  properly 
and  rationally  employed  by  competent 
operators,  should  prove  safer,  more  effica- 
cious and  acceptable  than  any  other  in  a 
majority  of  the  various  forms  of  this  trouble. 
Electricity  had  been  on  trial  with  very 
varying  results,  but  it  seemed  to  me  that 
the  discrepancies  were  attributable  to  the 
apparatus  employed  or  to  the  operator,  and 
that  we  did  not  fully  appreciate  its  value. 


The  literature  on  the  subject  was  con- 
flicting, misleading  and  most  disappoint- 
ing. -Electricity  was  discredited,  and 
other  methods  advocated  fraught  with 
gravest  menace  to  the  patient's  future - 
health,  usefulness  and  happiness,  in  the 
event  of  recovery,  from  the  immediate 
results  of  the  procedures,  and  recent  liter- 
ature shows  little  improvement. 

Here,  surely,  was  a  promising  field  for 
research,  and  I  determined  upon  a  careful 
investigation. 

The  immediaite  vicinity  of  Toronto  is 
not  goitrous,  yet  as  a  recognized  medical 
and  surgical  centre  it  draws  many  cases 
from  an  extensive  territory  around,  and  in 
the  great  majority  of  these  cases  the  best 
known  therapeutic  measures  adopted  by 
the  general  profession  have  already  been 
resorted  to.  My  connection  with  Toronto 
hospitals  places  me  in  a  most  favorable 
situation  with  regard  to  the  supply  and 
character  of  this  clinical  material,  and  a 
number  of  our  prominent  practitioners 
have  very  kindly  referred  to  me  their  pri- 
vate as  well  as  their  hospital  patients,  thus 


98 


THE  CANADA  MEDICAL  RECORD. 


testifying  to  the  unsatisfactory  state  of  the 
therapeusis  of  the  thyroid  as  well  as  to  the 
success  of  my  labors.  This  is  most  grati- 
fying to  me,  and  greatly  to  the  credit  of 
my  professional  brethren,  well  illustrating 
their  broad  and  progressive  spirit  in  con- 
trast to  the  opposition  to  methods  electri- 
cal manifested  in  other  quarters.  Improv- 
ed apparatus  and  methods  have  retrieved 
past  failures,  and  rendered  possible  results 
hitherto  unattainable. 

The  discussions  elicited  by  my  former 
papers  disclosed  a  decided  variance  of 
opinion  as  to  the  value  and  range  of  applic- 
ability of  electrical  treatment,  and  demon- 
strated the  need  and  incalculable  useful- 
ness of  our  Association.  I  have  again  to 
report  progress  and  state  the  deductions 
from  a  year's  further  experience.  My  aim 
has  been  to  shorten  the  period  of  treatment, 
while  extending  the  interval  between 
seances,  to  improve  technique  and  to  dis- 
criminate the  treatment  most  appropriate 
to  each  case. 

The  percutaneous  method,  using  strong 
currents  by  means  of  flexible  clay  elec- 
trodes, has  received  considerable  attention. 
I  have  found  it  very  tedious,  and  have  come 
to  the  conclusion  that  its  chief  utility  lies  in 
combating  the  hyper?emic  condition,  in  re- 
ducing simple  hypertrophy,  in  stimulating 
liquefaction  and  absorption  of  recent  fibroid 
growth,  and  lessening  the  cedema  of  older 
cases  preparatory  to  more  active  measures. 
It  may  also  be  employed  where  puncture 
^vould  not  be  well  borne,  and  occasionally 
to  alternate  with  puncture  treatments. 

Thyroid  hypenemia  occurring  at  the 
menstrual  period  or  during  pregnancy,  and 
disappearing  at  their  termination,  does  not 
call  for  interference,  unless  there  be  acces- 
sion of  size  at  each  period  or  gravid  state. 
Galvanization  of  the  sympathetic  should 
then  be  resorted  to,  with  occasional  clay 
pad  percutaneous  treatment  if  necessary. 
This  remark  also  applies  to  goitrous  cases 
of  amenorrhcta,  \\hcther  primitive  or 
secondary. 


I        In  the  slighter  forms  of  hyperplasia,  the 

clay  electrode    treatment  is  indicated,  the 

I  positive    electrode   at  the    back    and    the 

'  negative    over     the,  goitre,    starting   with 

!  20m.a.  to  30m. a.     The  patient  will,  after  a 

few  sittings,  gradually  tolerate    loom.a.  to 

1 50m. a.  for  ten  or  twelve  minutes  two  or 

three  times  a   week. 

In  vascular  forms,  by  diminishing  exces- 
sive blood-supply  and  stimulating  absorp- 
tion, we  induce  a  process  of  partial  atrophy. 
The  negative  electrode,  a  large  clay  pad,  is 
placed  at  the  shoulders,  while  the  active 
surface  of  the  positive  (a  properly  insulated 
platinum  needle)  is  introduced  within  the 
capsule  of  the  gland  alongside  a  tenotomy 
knife.  Of  course,  a  local  anaesthetic  i 
first  used.  From  50m. a.  to  1 50m. a.  should 
be  employed  for  eight  to  ten  minutes  every 
ten  or  twelve  days. 

In  distinctly  fibroid  forms,  the  nutritive 
process  may  be  lessened  by  the  positive 
puncture,  with  occasional  .resort  to  the 
negative  needle  to  hasten  absorption.  In 
some  advanced  fibroid  cases  where,  owing 
to  the  small  proportion  of  healthy  tissue 
left,  the  process  of  absorption  and  atrophy 
was  slow,  I  have  hastened  matters  by  the 
formation  of  a  central  cavity  or  artificial 
cyst.  This  I  have  done  by  large  negative 
needles,  treating  it  as  an  ordinary  C}'st  and 
maintaining  drainage.  It  requires  specially 
careful  manipulation.  In  very  large 
fibroids,  I  frequently  discard  the  clay  pad, 
and  use  instead  a  second  needle  in  another 
portion  of  the  growth. 

Thin-walled  unilocular  cysts  are  the 
most  amenable  to  treatment.  The  positive 
pad  is  placed  at  the  shoulders,  while  the 
negative  electrode  is  an  insulated  canula, 
through  which  the  cyst  is  aspirated  and  a 
solution  of  chloride  of  sodium  introduced. 
From  50m. a.  to  lOom.a.  is  employed  for 
ten  minutes,  the  cyst  again  emptied  and 
firm  pressure  maintained  by  broad  adhe- 
sive straps.  A  single  treatment  may  suf- 
fice, but  frequently  in  the  thick-walled  and 


THE   CANADA   MEDICAL   RECORD. 


99 


multilocular  varieties  drainage  must  also 
be  kept  up  to  permit  escape  of  the  fluid 
effused  subsequent  to  the  operation.  The 
aim  is  thus  to  obliterate  the  sac  by  excit- 
ing adhesive  inflammation  of  its  walls. 

Thick-walled  fibro-cysts  are  often  very 
rebellious.  Following  the  above  treatment 
I  have  introduced  a  solution  of  zinc  sul- 
phate through  a  tube  which  carries  a  posi- 
tive platinum  wire,  and  employed  50m. a. 
to  7 5m. a.  for  ten  or  twelve  minutes.  I 
have  also  used   a   zinc  positive  electrode. 

When  the  contents  of  a  cyst  are  not 
sufficiently  fluid  to  pass  through  the  canula, 
some  of  the  saline  solution  should  be  forced 
in,  and  currents  of  50m. a.  to  loom.a,,  or, 
if  the  patient  will  tolerate  it,  and  it  is 
necessary,  I50m.a.  to  200m. a.  employed. 
This  will  liquefy  the  contents,  which  may 
be  withdrawn  immediately  or  at  the  fol- 
lowing seance  eight  or  ten  days  later. 

Puncture  of  the  thyroid,  apart  from  elec- 
trical treatment,  is  not  devoid  of  danger. 
Considerable  dexterity  is  required,  and  a 
slight  error  may  prove  disastrous.  When 
in  addition  to  this  we  consider  the  power 
of  the  agent  employed,  it  will  easily  be 
understood  that  great  care  is  requisite 
both  during  and  subsequent  to  the  opera- 
tion. Cleanliness  and  strict  antisepsis 
are  imperative.  Drainage  should  not  be 
unnecessarily  prolonged. 

With  regard  to  exophthalmic  goitre,  I 
have  nothing  novel  to  offer.  I  meet  very 
few  genuine  cases,  and  think  that  the  Fel- 
lows fully  appreciate  the  value  of  galvan- 
ization of  the  sympathetic  and  other  elec- 
trical methods. 

I  have  modified  the  canula  and  attach- 
ment of  the  Potain  aspirator  by  enlarging 
the  lumen  to  permit  the  easy  passage  of 
No.  3  drainage  tubing.  I  have  had  the 
tube  of  the  canula  constructed  of  platinum. 
It  may  thus  be  used  with  the  positive  pole  ; 
and  I  have  added  a  second  stopcock,  which 
renders  it  independent  of  the  reservoir. 

As  the  use  of  chemical  solutions  corrodes 


metal  parts,  I  employ  for  injection  a  second 
bottle,  with  tubes  of  glass  leading  to  and 
from  it.  I  have  also  furnished  it  with  a 
third  tube  to  facilitate  the  introduction  of 
the  solution.  Provision  is  also  made  for 
emptying  the  sac  after  treatment  without 
polluting  the  contents  of  reservoir. 

The  possession  and  care  of  the  neces- 
sary apparatus,  and  the  ability  to  employ 
it  skilfully,  minute  acquaintance  with  fund- 
amental laws,  and  a  proper  estimation  of 
the  power  of  this  agent,  are  only  a  few 
of  tj'ie  factors  which  militate  against  the 
electrical  treatment  of  goitre  by  the  gen- 
eral practitioner,  and  he  will  be  wise  if  he 
resist  the  temptation  to  use  it. 

Finally,  the  keynote  of  success  is  dis- 
crimination. 

§0crctg    firoceebings. 

MONTREAL  MEDICO-CHIRURGICAL 

SOCIETY. 

Stated  Meeting,  November  2nd,   1894. 

G.  P.  GiRDwooD,   M.D.,   President,  in  the- 

Chair. 

Case  of  Primary  Carcinoma  of  the  Liver. — 
Dr.  Martin  read  for  Dr.  Adami  the  report  on 
this  case  as  follows. 

During  the  last  session  of  the  Society  I 
brought  before  the  Montreal  Medico-Chirurgi- 
cal  Society  a  case  of  true  adenoma  affecting  the 
liver  of  a  woodchuck,  and  arising  primarily,  as 
its  structure  amply  demonstrated,  from  the  par- 
enchyma of  that  organ. 

I  have  now  to  describe  you  a  case  of  very 
similar  nature  in  the  human  liver,  only  here  the 
adenoma  has  taken  on  a  malignant  character, 
and  secondary  growths  have  developed  else- 
where. 

The  specimen  was  obtained  at  a  post-mor- 
tem made  at  the  Royal  Victoria  Hospital  on 
September  4th.  The  subject  from  whom  it  was 
obtained,  J.  B.,  aged  45,  entered  the  hospital 
under  Dr.  Stewart,  complaining  of  weakness 
and  loss  of  fiesh,  with  pain  and  swelling  in  the 
abdomen.  He  had  been  addicted  to  good  liv- 
ing and  excessive  use  of  alcohol,  and  there  was 
a  doubtful  specific  history.  About  a  year  be- 
fore admission  there  had  been  a  violent  attack 
of  jaundice,  from  which  patient  gradually  re- 
covered. 

The  liver  dulness  extended  from  the  fifth  rib 


lOO 


THE   CANADA   MEDICAL   RECORD. 


to  two  inches  below  the  costal  margin,  the 
edge  was  sharp,  while  the  anterior  surface  pre- 
sented a  nodular  mas'-  the  size  of  the  fist,  mov- 
able with  the  liver. 

This  lump  in  the  right  side,  noted  now  to  be 
in  conneclion  with  the  liver,  was  first  observed 
five  months  ago. 

Without  dwelling  fully  upon  the  condition  of 
the  other  organs,  it  may  be  added  that  there 
was  much  ascites.  The  patient  was  tapped 
twice,  and  each  time  a  bloodstained  ascitic 
fluid  was  removed  containing  both  red  and 
white  corpuscles  and  urea  ;  it  was  highly  albu- 
minous. 

With  this  history  a  diagnosis  was  made  of 
cancer  of  the  liver.  The  autopsy  fully  con- 
firmed this  diagnosis. 

In  connection  with  the  liver  within  the  sub- 
stance of  the  right  lobe  was  the  large  pale-col- 
ored mass  seen  in  the  specimen  handed  round. 
Upon  the  surface  were  several  semi-transpa- 
rent nodules  of  new  growth  in  the  capsule,  but 
upon  section  the  only  recognizable  focus  of 
new  growth  within  the  organ  was  the  one  large, 
well-defined  mass.  This  mass  was  10,5  cm. 
broad  and  14  cm.  long,  sharply  separated  off 
from  the  surrounding  liver  tissue  ;  it  was  placed 
anteriorly  at  the  left  extremity  of  the  right 
lobe  and  to  the  left  of  the  gal)  bladder.  This 
last  was  greatly  thickened  and  pressed  to  the 
right  by  the  growth.  Upon  opening,  it  was 
found  to  be  full  of  thick,  brownish-grey  pulta- 
ceous  mass  of  mixed  pus  and  bile,  with  such 
intense  staining  power  that  even  now  upon 
November  2nd  the  nail  of  my  left  index  finger 
is  stained  from  exploring  the  gall  bladder  of 
this  case  upon  September  4th.  In  this  mass 
lay  several  soft  small  facetted  gall  stones,  which 
easily  crumbled  and  broke  down  when  handl  ;d. 
Two  larger  and  firmer  stones  lay  at  the  open- 
ing of  the  cystic  duct,  and  appeared  to  com- 
pletely block  it. 

The  great  omentum  was  greatly  thickened 
and  of  a  deep  blood-stained  tint,  very  nodular 
and  brittle.  The  small  intestines  presented 
numerous  semi-transparent  nodular  growths 
upon  their  serous  surfaces.  There  were  fur- 
ther numerous  small  nodules  scattered  through 
the  mesentery,  and  imbedded  in  the  fat.  There 
was  no  sign  of  new  growth  anywhere  within 
the  intestinal  tract. 

Beyond  cedcma  of  the  lungs  and  interstitial 
nephritis,  there  was  little  calling  for  additional 
remark. 

Upon  microscopic  examination  the  new 
growths  here  described  were  typically  carcin- 
omatous, of  the  medullary  type.  The  threat 
size  of  the  mass  in  the  liver,  as  compared  with 
the  minute  nature  of  the  nodules  elsewhere, 
appeared  to  indicate  that  in  the  liver  was  the 
primary  growth,  and  microscopic  examination 
proved  the  correctness  of  this  suggestion.  More 
especially  towards  the  ^'rowing  free  surface  the 


mass  could  be  seen  to  be  composed  of  charac- 
teristic liver  cells,  large,  tending  to  be  cubical 
and  pigmented,  possessing  a  teiidency  to  be 
arranged  in  an  alveolar  manner.  Elsewhere, 
deeper  down  in  the- tissue,  the  cells  became 
smaller  and  the  collections  were  separated  off 
from  each  other  by  well  formed  fibrous  stroma. 
In  parts  there  was  a  tendency  for  the  cells  to 
be  arranged  around  a  central  lumen. 

The  sections,  in  fact,  possessed  all  the  char- 
acteristics of  an  adenoma,  or  new  growths  of 
the  liver  tissue  which  had  taken  on  malignant 
characters.  This  malignancy  was  further  de- 
monstrated by  the  abundant  new  growths  in 
the  abdominal  cavity. 

Primary  carcinoma  in  the  liver  may  be  of 
three  types : 

1.  Generalized  carcinoma,  the  cirrhosis  car- 
cinomatose,  of  Peres. 

2.  Localized  carcinoma  orginating  from  the 
liver  cells  proper. 

3.  Localized  carcitioma  originating  from  the 
smaller  bile  ducts. 

A  fourth  form,  not  truly  hepatic,  invades  the 
liver  after  primary  origin  in  the  larger  bile 
duels. 

Here  in  this  ca,se  we  are  dealing  with  the 
second  form,  that  is  to  say,  with  a  true  liver 
cell  cancer,  which  is  of  sufficient  rarity  to  be 
placed  on  record. 

Finally,  it  is  interesting  to  observe  the  rela- 
tionship that  in  this  case  appears  to  exist  bet- 
ween the  inflammatory  disturbance  of  the  gall 
bladder,  which  dated  back  a  year,  and  the  can- 
cer which  has  arisen  in  close  juxtaposition  to 
the  inflamed  bladder.  The  suggestion  is  that 
some  relation  exists  between  the  two.  It  is 
noticeable  that  the  gill  hladder  itself  exhibits 
no  cancerous  growth  ;  it  is  only  chronically 
inflamed,  but  immediately  outside  it,  in  the 
region  that  is  of  congestion,  and  over-nutrition 
of  the  tissue  has  originated  this  new  growth. 

Primary  Carcinoma  of  tlic  Kidney. — Dr. 
Martin  then  exhibited  a  specimen  which  had 
been  removed  from  a  private  case  of  Dr.  Mc- 
Carthy's, who,  with  Dr.  Finley,  in  consultation, 
had  diagnosed  primary  carcinoma  of  the  kidney. 
The  autopsy  confirmed  this  diagnosis.  The 
kidney  shown  appeared  enlarged,  the  capsule, 
Dr.  Martin  declared,  was  in  some  parts  stripped 
off  with  diflFicuIty,  and  on  section  a  large  can- 
cerous tumor  was  seen  infiltrating  the  medul- 
lary portion,  filling  the  pelvis,  and  extending 
to  the  suprarenals.  Thrombi  were  found  in 
the  renal  vein,  although  the  vena  cava  was 
free. 

Dr.  A.  Lapthorn  S.mith  presented  the 
following  specimens,  and  related  the  histories 
of  the  cases  : 

Case  I. — Multilocular  Cyst  of  the  Ri^^^/it 
Ovary. — The  tumor  measured  24  inches  in 
circumference.  The  patient,  Mrs.  L.,  nullipara, 
married  two  years,  never   pregnant.      Abdom- 


THE   CANADA    MEDICAL   RECORD. 


lOI 


inal  enlargement  first  noticed  sixteen  months 
ago.  On  examination,  all  the  evidences  of 
ovarian  cyst  were  found.  Operation  was  per- 
formed on  September  4th,  the  tumor  removed 
without  any  difiicully,  and  she  made  a  rapid 
recovery,  returning  home  twenty-five  days  after- 
wards. 

Case  2. —  Tubal  Pregnancy .--Mxi.  W.,  aged 
25,  married  3  years,  mother  of  two  children, 
the  youngest  one  year  old.  Since  the  birth  of 
her  first  child  she  had  suffered  from  repeated 
attacks  of  what  was  probably  pelvic  peritonitis. 
Five  weeks  before  coming  under  his  notice  she 
was  suddenly  seized  with  a  severe  i)ain  in  her 
left  side  and  a  fainting  fit  while  walking  in  the 
street.  She  began  to  flow,  and  continued  until 
time  of  operation.  As  she  had  not  missed  a 
period  she  w.is  sure  it  was  not  a  miscarriage, 
and  in  a  few  days  was  about  again.  Two  weeks 
later  she  had  another  fainting  attack,  accom- 
panied by  sharp  cutting  pain,  and  a  third  one 
week  before  he  was  called  to  see  her  in  consult- 
ation. On  examination  he  found  a  mass  the 
size  of  a  small  orange  in  Douglas'  cul-desac, 
and  it  was  exceedingly  sensitive  to  pressure. 
Tubal  pregnancy  was  at  once  diagnosed,  and 
operation  performed  on  October  20th.  In 
order  to  make  the  recovery  more  satisfactory, 
he  dilated  and  curetted  the  uterus,  sewed  up 
the  cervix,  and  performed  ventral  fixation  after 
the  removdl  of  the  appendages.  The  dates  of 
the  various  haemorrhages  were  beautifully  illus- 
trated when  the  speciinen  was  first  removed  by 
the  clots  of  blood  surrounding  it.  There  was 
rather  bright  red  blood  recently  escaped,  dark 
and  slightly  organized  clots,  and  old  hard  clots, 
more  dense  and  firm.  Dr.  McC.'onnell  had 
made  a  microscopical  examination,  and  had 
only  been  able  to  find  blood-clot,  but  further 
search  would  be  made  for  chorionic  villi. 

Case  3.  Hcematoma  of  the  left  Ovary — Chro- 
nic Salpingitis. — Mrs.  L.,  aged  25,  has  been  a 
chronic  invalid  since  the  birth  of  her  only 
child,  eighteen  months  ago.  On  examination, 
deep  bilateral  laceration  of  the  cervix  and  on 
the  left  side  near  the  uterus  a  lump  about  the 
size  of  k  small  orange.  After  a  course  of  pre- 
liminary treatment  for  reducing  congestion  of 
the  pelvic  organs,  operation  was  performed  on 
September  6ih.  The  uterus  was  dilated  and 
curetted,  the  laceration  was  carefully  repaired, 
and  both  appendages  removed.  The  perito- 
neum and  fascia  were  closed  with  buried  silk 
and  a  layer  of  through  and  through  silkworm 
gut  stitches  which  had  been  passed  previously 
were  tied.  The  patient  made  a  good  recovery. 
The  silk-worm  gut  sutures  were  removed  four 
weeks  after  operation. 

Embryo  in  Sac. — Dr.  Hutchison  exhibited 
a  specimen  of  an  embryo  in  its  sac,  surround- 


ed by  the  liquor  aiuini.  It  was  of  interest,  he 
thought,  from  its  rarity,  such  a  complete  pic- 
ture of  the  early  development  of  the  human 
species  not  being  often  ^seen  outside  of  text- 
book plates.  The  abdominal  opening  could 
be  plainly  seen  and  the  small  jioints  marking 
the  situation  of  the  eyes,  etc.,  etc. 

Stated  Meeting,  Not  ember  \6th,  1894. 

G.  P.  GiRDwooi),  M.D.,  President,  in  the 
Chair. 

Drs.  T.  E.  Binmore,  Felix  Cornu,  William 
Burnett  and  H.  M.  Duhamel  were  elected 
ordinary  members. 

Diaphragmatic  Hernia. — Dr.  Adami  exhi- 
bited the  specimen  and  gave  the  history  of  the 
case. 

Dr.  Mills  remarked  that  between  the  years 
1878  and  i88i,he,  then  a  resident  physician  in 
the  City  Hospital  of  Hamilton,  Ont.,  reported 
a  case  of  congenital  hernia  through  the  dia- 
phragm in  an  infant.  He  did  not  rem  -mber  what 
organs  had  passed  upward  through  the  orifice, 
nor  whether  there  were  any  other  Canadian 
cases  on  record. 

In  reply  to  questions  put  by  the  President, 
Dr.  Adami  remarked  that  this  would  be  consi- 
dered of  the  congenital  variety  ;  that  it  would 
seem  to  be  caused  by  the  non-development  of 
the  left  crus  of  the  diaphragm  ;  and  that  the  most 
common  position  of  the  rupture  or  orifice  in 
the  diaphragm  was  the  tendinous  portion  of 
the  left  side. 

Pus  Tubes  and  Hcematoma  in  the  same  pa- 
tient. Pus  Tubei  removed  during  an  Acute 
Attack  of  Peritonitis.  Double  Hydrosalpinx, 
causing  Severe  Dysmenorrha;a — Dr.  A.  Lap- 
thorn  Smith  read  the  reports  of  these  cases, 
as  follows  :— 

Case  I.  Haematoma  of  Ovary  wi  h  Double 
Pus-tubes. 

Miss  C.  was  referred  to  me  as  a  case  of 
fibroid  tumor  of  the  uterus  and  as  being  suit- 
able for  electrical  treatment.  This  diagnosis 
was  not  without  some  foundation,  for  on  placing 
the  hand  on  the  abdomen,  one  could  detect 
a  tumor  or  enlargement  of  the  uterus,  extend- 
ing nearly  to  the  umbilicus.  By  bimanual 
palpation  the  cervix  was  found  to  be  small,  but 
the  uterus  appeared  large  and  wedged  in  the 
pelvis,  and  quite  immovable.  The  tubes  and 
ovaries  could  not  be  felt.  On  firm  i)ressure 
the  tumor  was  felt  to  be  solid,  or  in  places 
slightly  elastic.  The  history  rather  supported 
the  diagnosis.  She  was  26  years  of  age  ;  had 
begun  to  menstruate  at  the  age  of  fourteen,  the 
flow  always  having  been  profuse.  It  had  never 
been  painful  until  six  years  ago,  since  which 
the  pain  of  the  periods  had  been  giadually  giow- 


IG2 


THE   CANADA   MEDICAL   RECORD. 


ing  more  severe,  until  she  was  at  length  com- 
pelled to  go  to  bed  every  month.  Latterly  the 
pain  had  been  much  ^vor^e  a  week  after  ihe 
periods  than  it  was  during  the  flow.  She  had 
had  several  attacks  of  pelvic  peritonitis  during 
the  last  year.  Electricity  was  discontinued,  as 
the  patient  did  not  improve.  Nothing  remained 
for  me  then  but  to  open  the  abdomen  and 
remove  the  appendages,  which  would  stop  the 
pain  and;  it  was  hoped,  arrest  the  growth  of 
the  tumor  and  the  hemorrhage.  Prepara- 
tions were  also  made  for  extirpating  the  uterus 
shoald  the  necessity  for  it  arise.  The  abdo- 
men was  opened,  after  the  usual  preparations, 
on  the  7th  September.  On  introducing  my 
fingers  to  search  for  the  appendages,  the  latter 
could  not  be  felt :  the  tumor  was  adherent  to 
the  pelvis,  and  it  was  covered  to  a  large  extent 
by  adherent  intestines.  The  adhesions  were 
broken  up,  when  for  the  first  time  it  became 
apparent  that  the  tumor  was  made  up  of  sev- 
eral different  elements.  After  some  difficulty 
a  pus  tube  was  brought  out,  which  was  tied 
close  to  the  uterus,  but  was  so  disorganized 
that  the  ligature  cut  through.  I  then  came 
upon  a  slightly  fluctuating  mass,  the  size  of  an 
orange,  which  was  also  dissected  out,  proving 
to  be  a  heematoma  of  the  left  ovary,  but  it  broke 
while  being  delivered  and  its  dark  grumous 
contents  escaped,  weUingup  out  of  the  incision. 
This  was  carefully  sponged  away,  and  the  ovary 
was  tied  and  removed.  A  large  pus  tube  was 
then  removed  from  the  right  side,  and  finally 
the  right  ovary,  which  was  somewhat  enlarged. 
Nothing  now  remained  of  the  tumor  but  a  nor- 
mal-sized uterus,  from  which  the  peritoneum 
was  completely  removed,  and  from  which  there 
was  a  good  deal  of  oozing.  When  this  had 
been  stopped,  a  glass  drainage  tube  was  in- 
serted, and  the  abdomen  closed  by  through  and 
through  silk  worm  gut  sutures  which  were  left 
in  one  month.  Six  ounces  of  bloody  serum 
were  pumped  from  the  drainage  tube,  when  the 
liquid  becoming  paler  the  tube  was  removed 
in  forty-eight  hours.  The  patient  declared  the 
following  day  that  the  pain  which  she  had 
suffered  for  several  years  was  entirely  gone, 
and  the  pain  of  the  operation  was  nothing  com- 
'  pared  to  it.  She  was  up  in  two  weeks,  and 
went  home  on  the  twenty-third  day. 

This  case  was  especially  interesting  to  me 
for  several  reasons :  First,  it  bore  out  the 
truth  of  Apostoli's  assertion,  that  a  patient  who 
cannot  bear  moderate  dosi-s  of  electricity  has 
diseased  tubes,  and  should  be  treated  by  sur- 
gery. Second,  it  bears  out  the  truth  of  Law- 
son  '1  ait's  assertion,  that  one  can  never  be  sure 
of  what  he  will  find  in  the  al)domen  until  he  has 
his  fingers  in  it,  indeed  I  might  add  the  words, 
"and  sometimes  not  even  then."  When  we 
remember  that  Lawson  Tait  has  opened  the 
abdomen  more  often  than  any  other  man  who 
has  ever   lived,  and  when    we   consider   what 


enormous  experience  that  meant,  no  one  should 
consider  liimself  infallible  in  this  respect.* 

Case  II.  Pus  tubes  removed  during  an  acute 
attack  of  peritonitis.     Recovery. 

The  patient  was  twenty-six  years  of  age, 
married  at  twenty  and  had  three' children.  She 
had  never  been  well  since  her  marriage,  but 
had  been  getting  very  much  worse  since  two 
years.  Her  last  child  was  a  year  old,  and  she 
had  no  miscarriages.  While  pregnant  with  her 
last  child  she  had  suffered  a  good  deal,  and  had 
had  a  bad  recovery.  During  the  past  year  she 
had  had  several  attacks  of  peritonitis,  confining 
her  to  bed  for  several  weeks  each  time.  Two 
weeks  before,  she  was  taken  with  an  unusually 
severe  attack,  from  which  her  physician  did 
not  expect  her  to  recover.  She  was  very  ema- 
ciated, was  constantly  crying  out  with  pain,  in 
spite  of  large  doses  of  opium,  while  her  abdo- 
men, which  was  covered  with  poultices,  was 
very  much  distended,  her  pulse  being  thready 
and  fast,  and  her  temperature  high.  She  was 
at  once  put  on  salines  and  large  doses  of  qui- 
nine, with  almost  immediate  relief  of  the  pain 
and  distension.  But  her  temperature  remained 
at  103.  On  examination,  per  vaginam,  Dou- 
glas' culde-sac  was  found  to  be  full  of  exuda- 
tion, which  was  thought  to  be  due  to  pus  tubes 
and  ovaries.  As  it  was  the  opinion  of  all  that 
she  could  not  continue  very  long  as  she  was 
doing,  it  was  decided  to  operate  that  afternoon. 
The  patient  absolutely  refused  to  leave  her 
house,  so  the  operation  was  performed  there. 
Both  tubes  were  dug  out  with  great  difficulty, 
being  imbedded  in  layers  of  exudation  in  va- 
rious stages  of  organization,  but  without  rup- 
turing them.  One  tube  tore  out  of  the  ligament 
while  extracting  it,  and  both  cut  like  cheese 
when  the  ligature  was  applied.  Notwithstand- 
ing this,  there  was  very  little  oozing.  Owing 
to  the  very  large  area  from  which  the  perito- 
neum was  stripped  off,  I  thought  it  best  to  put 
in  a  drainage  tube,  which  was  left  in  only  one 
day.  'J'he  temperature  took  three  days  to  fall 
to  normal,  and  the  pulse  improved  steadily, 
although  she  was  not  able  to  leave  her  bed  for 
five  weeks.  When  last  heard  from,  she  was  im- 
proving steadily. 

Case  III.  Hydrosalpinx  and  bound  down 
tubes  and'ovaries,  causing  severe  dysmenor- 
rhoea.     Removal.     Recovery. 

Miss  B.,  30  years  of  age,  had  been  under 
my  care  for  several  years  for  severe  dysmenor- 
rhcea,  and  almost  constant  pain  between  the 
periods.  Palliative  treatment  having  proved  of 
little  avail,  removal  of  the  appendages  was 
suggested,  and  she  readily  agreed  to  have  that 
done.     Coeliotomy  was  performed  on  the  13th 

xhincc  wriliny  the  above,  a  paper  by  Dr.  J.  F.  W. 
^\.oSs,of  Toronto,  has  appearei.1  in  the  Atnerican  Journal 
of  Vbsietiics,  in  whicli  he  reports  several  cases  in  which 
he  removed  hu<^e  pus  tubes  from  women  who  had  been 
sent  to  liini  for  til>roid. 


THE   CyVNADA   MEDICAL   RECORD. 


103 


October.  Although  the  ovaries  and  tubes  were 
covered  with  adhesions,  the  latter  were 
easy  to  break,  and  both  tubes  and  ovaries 
were  removed,  and  the  uterus  attached  to  the 
abdominal  wall.  No  drainage  tube  was  used. 
The  fascia  was  sewed  with  catgut,  and  the  silk 
worm  gut  previously  introduced  was  then  tied. 
She  made  a  successful  recovery,  being  up  in 
two  weeks.  On  examining  the  tubes  they  were 
both  found  to  be  distended  with  fluid,  which 
could  be  squeezed  (  ut  of  thtir  uterine  ends  in 
a  clear  stream,  but  it  was  impossible  to  intro- 
duce the  finest  filiform  bougie  into  the  uterine 
ends  at  all,  and  only  a  distance  of  half  an  inch 
into  the  fimbriated  ends.  The  tubes  were  bent 
by  adhesions  so  as  to  form  a  number  of 
knuckles,  which  were  probably  the  cause  of  the 
severe  pains  every  month.  One  ovary  had  a 
cyst  in  it,  which  ruptured  while  removing  ii, 
and  into  which  one  can  introduce  the  end  of 
the  thumb.  It  apparently  contained  clear 
fluid.  The  other  ovary  has  a  thick  hard  sur- 
face, due  apparently  to  chronic  inflammation 
of  the  peritoneal  coat.  When  the  ovaries  and 
tubes  when  first  removed  were  placed  in  water, 
they  were  found  to  be  covered  with  fringes  of 
shreds  representing  the  torn  adhesions.  Dr. 
Joseph  Price  had  a  quaint  way  of  saying  to  his 
assistant,  when  he  removed  appendages  like 
thet.e  :  "  Don't  let  these  tramps  out  until  they 
have  seen  the  specimens  in  water,  for  fear  they 
will  go  away  saying  that  they  had  seen  healthy 
ovaries  removed." 

It  will  be  admitted  that  if  one  cannot  relieve 
a  woman  in  these  circumstances  by  the  means 
which  were  employed  during  ihree  years  of 
treatment,  and  if,  at  the  end  of  t-.at  time,  she 
is  not  able  to  keep  a  situation  from  this  cause, 
we  are  fully  justified  in  removing  the  append- 
ages. My  experience  of  tearing  the  append- 
ages loose  and  leaving  them  to  contract  fresh 
adhesions  has  not  been  favorable,  and  I  have 
never  tried  to  save  distended  tubes  by  open- 
ing them  and  sewing  them  up  again,  as  I  feel 
sure  that  fresh  adhesions  would  continue  to 
worry  the  ovaries,  and  the  tubes  would  refill. 
Pozzi  and  Polk  have  been  doing  it,  but  from  j 
recent  reports  of  Polk's  cases  the  result  has  not  ] 
been  s.itisfactory.  [ 

Primg,ry  Carcinoma  of  the  Kidney. —  Dr. 
J.  G.  McCarthy  reported  this  case  as  follows  : 

The  rarity  of  primary  carcinoma  of  the  kid- 
ney in  the  adult  has  induced  me  to  give  a  short 
resume  of  the  clinical  aspects  of  a  case,  of 
which  the  specimen  has  already  been  brought 
before  the  Society. 

The  patient,  a  female,  aged  42,  was  married 
at  23,  and  has  had  eleven  children,  nine  of 
whom  are  living.  She  first  consulted  me  at  the 
latter  end  of  August  for  recurring  attacks  of 
pain  in  the  back  and  loss  of  strength.  The 
pain  was  severe,  and  extended  on  the  left  side 
from  the  lumbar  region  of  the  spine  to  the  front 


of  the  abdomen,  and  occasionally  was  felt  down 
the  left  thigh.  She  attributed  her  ill  health  to 
the  after-effects  of  her  previous  confinement. 
Notwithsianding  the  number  of  her  pregnancies, 
and  the  arduous  duties  of  a  large  t'amily  in  one 
in  poor  circumstances,  she  had  always  been  in 
good  health.  Two  months  previous  to  the  birth 
of  her  last  child,  which  occurred  on  the  3rd 
November,  1893,  she  commenced  to  suffer  with 
attacks  of  pain  in  the  back,  and  noticed  for 
the  first  time  that  the  urine  was  blood-stained 
and  coita'ned  blood  clots.  Her  confinement 
was  normal.  She  was  delivered  of  a  healthy 
chil  1  at  full  term,  and,  I  am  told,  went  to  her 
work  on  the  morning  of  the  fifth  day.  Two 
months  later  hgematuria  returned,  and  appeared 
at  intervals  in  small  quantities  till  June,  1894. 
The  pains  continued,  and  she  felt  weaker  and 
found  it  difficult  to  attend  to  her  household 
duties.  In  January  she  noticed  a  small  growth 
on  the  left  side  of  her  neck,  which  gradually 
increased  in  size,  and  had  occasionally  been 
the  seat  of  pain.  The  family  history  contained 
nothing  of  importance. 

When  first  seen  she  presented  a  pale,  care- 
worn expression,  and  was  somewhat  emaciated. 
The  tongue  was  clean ;  appetite  good ;  no 
vomiting  ]  bowels  fairly  regular,  but  she  had 
previously  suffered  from  obstinate  constipation. 
The'  pulse  was  115,  small  and  compressible; 
temperature  normal. 

In  the  neck  was  a  growth  about  the  size  of 
an  egg,  situated  in  the  triangular  interval 
between  the  sterno-mastoid  and  the  trapezius 
above  and  parallel  to  the  clavicle.  It  was 
hard  and  nodular  to  the  feel,  and  quite  mobile. 
The  cephalic  vein  of  that  side  was  dilated,  and 
pursued  an  unusual  course  across  the  front  of 
the  chest,  over  the  first  intercostal  space  to  the 
sternum.  I  looked  upon  the  tumor  as  most 
likely  a  secondaiy  growth,  originating  in  the 
cervical  lymphatic  glands.  'J'here  were  no 
signs  of  disease  in  the  mouth,  throat  or  thorax. 
The  apex  of  the  heart  was  displaced  upwards 
and  outwards  to  the  lower  border  of  the  4ih  rib 
in  the  mammary  line.  Percussion  dulness  was 
made  out  at  the  upper  border  of  the  3rd  costal 
cartilage^  nearly  two  inches  to  the  left  of  the 
median  line,  and  extended  from  the  apex  to 
nearly  across  the  sternum.  There  was  no  dis- 
tension of  the  abdomen.  Its  walls  were  soft, 
flaccid,  yielding  readily  to  pressure.  A  portion 
of  the  large  bowel,  distended  with  faecal  matter, 
could  be  easily  felt  beueath  the  abdominal 
parietes,  extending  from  the  ninth  costal  carti- 
lage in  the  mammary  line,  downwards  on  the 
confines  of  the  umbilical  and  left  lumbar 
regions.  Beneath  the  bowel,  which  I  thought 
was  the  descending  colon  displaced  forwards, 
could  be  f  It  a  large  growth,  quite  hard,  non- 
fluctuating,  with  a  smooth  and  rounded  contour, 
having  at  its  inferior  border  a  smooth  nodular 
projection. 


104 


THE   CANADA    MEDICAL   RECORD. 


The  tumor  extended  upwards  into  the  left 
hypochondriac  region  and  downwards  to  the 
left  iliac  fossa  through  the  left  lumbar  region  ; 
it  inclined  forwards  towards  the  umbilicus, 
receding  as  it  did  so  from  the  anterior  abdom- 
inal walls.  It  could  be  tilted  forwards,  with- 
out occasioning  any  pain,  by  pressure  behind 
over  the  region  of  the  kidney  ;  in  other  direc- 
tions it  was  quite  fixed.  Percussion  dullness 
extended  to  tlie  lower  border  of  the  6th  rib 
outside  the  nipple  line,  and  posteriorly  over  the 
region  of  the  kidney  a  slight  bulging  was 
noticed. 

There  was  no  dilation  of  the  superficial  veins, 
and  no  oedema  of  the  extremities.  The  urine 
was  examined  on  two  different  occasions.  The 
quantity  excreted,  though  not  measured,  seem- 
ed normal.  Nothing  could  be  inferred  from 
the  sp.  gr.  or  color.  It  was  acid  in  reaction, 
and  contained  neither  albumen  nor  sugar  ;  but. 
when  examined  microscopically,  blood  cells 
were  distinctly  visible  and  urates  were  present 
in  large  quantities. 

The  disease  progressed  without  any  apparent 
signs  of  hsematuria.  The  patient  became  more 
emaciated  :  thsre  was  some  increase  in  the  size 
of  the  tumor,  and  the  exacerbations  of  pain 
towards  the  end  became  more  frequent  and 
more  severe.  A  slight  rise  of  temperature  was 
noticed,  on  two  occasions,  to  loo'^  and 
100.3^  F. 

The  last  two  or  three  weeks  were  marked  by 
an  uncontrollable  diarrhoea.  The  patient  now 
took  to  her  bed,  and  from  this  out,  the  loss  of 
strength  was  very  rapid,  and  the  emaciation 
extreme,  and  she  died  on  the  31st  October. 
Dr.  Finlay  saw  the  patient  with  me  .t  the  latter 
end  of  her  illness,  and  agreed  with  the  diagnosis. 

Remarks. — The  invasion  of  the  cervical 
glands  of  the  left  side  of  the  neck,  the  freedom 
from  disease  of  the  other  superficial  lymphatic 
glands,  is  worthy  of  note.  It  was  this  that 
gave  me  the  first  clue  to  the  possibility  of 
malignant  disease.  I  ordered  the  patient  to 
bed,  and  made  a  thorough  examination  in  search 
of  the  primary  growth.  It  was  only  after  this 
was  localized  that  any  mention  of  ha^maturia 
was  made  by  the  patient.  In  tracing  the  course 
qf  this  secondary  infection  from  the  primary 
disease  in  the  kidney,  I  believe  that  it  was 
conveyed  by  the  l}mphatics  of  the  kidney  to 
the  thoracic  duct  and  by  this  channel  to  the 
lymphatic  glands  of  the  left  side  of  the  neck. 
1  feel  more  inclined  to  this  opinion  after  noting, 
at  the  post-mortem,  the  condition  of  the  retro- 
peritoneal glands  in  the  neighborhood  of  the 
kidney. 

Hsemaluria  had  appeared  early,  had  never 
been  profuse,  and  for  ti)e  last  five  months  of 
the  illness,  was  reduced  to  a  mere  trace,  which 
required  a  microscopical  examination  to  deter- 
mine. 

At  the  post-morlem  tiie  transverse  colon  was 


noticed  to  be  uncovered  by  the  great  omentum, 
and  extended  downwards  from  the  hepatic 
and  splenic  flexures  to  a  point  below  the  umbi- 
licus. Although  the  intestine  was  at  that  time 
quite  empty,  from  the  severe  diarrhoea  that  had 
preceded  death,  I  think  now  that  possibly  that 
portion  of  the  large  bowel,  which  could  be  so 
distinctly  felt  in  life,  was  part  of  the  transverse 
colon  from  its  raid-point  below  to  the  splenic 
flexure,  which  in  its  abnormal  position  ascended 
almost  vertically  in  front  of  the  tumor. 

Another  point  which  I  might  mention,  though 
I  consider  it  merely  as  a  coincidence,  was  the 
acidity  of  the  saliva.  It  was  tested  with  strips 
of  litmus  paper,  placed  over  the  orifices  of  the 
ducts.  I  made  four  tests  at  intervals  of  a  few 
days.  Three  times  the  reaction  was  acid,  once 
neutral. 

Pathological  Report. — The  whole  growth 
manifests  the  ordinary  character  of  a  primary 
medullary  carcinoma  of  the  kidney  arising  from 
the  epithelium  of  the  renal  tubules.  It  shows 
in  places  the  true  glandular  form  of  carcinoma, 
first  described  by  Waldages,  and  indicated 
clearly,  from  microscopic  specimens,  how  the 
tumor  cells  proliferating  from  the  kidney 
epithelium  becomes  gradually  smaller  and  like 
atypical  cells  of  this  organ,  while  the  stroma  of 
the  cancerous  mass  takes  its  origin  from  the 
intertubular  connective  tissue. 

The  progress  of  the  case  has  likewise  been 
of  interest,  inasmuch  as  its  advance  by  the 
lymphatics  is  the  more  unusual  form  of  primary 
renal  carcinomata,  but  the  growth  in  the  neck 
is  undoubtedly  to  be  regarded  as  secondary  to 
the  kidney  affection,  metastases  having  formed 
through  the  thoracic  duct  and  by  retrograde 
advance  to  the  lymphatic  glands. 

Primary  cancers  of  the  kidney  do  not,  as  a 
rule,  form  secondary  growths,  and  when  these 
occur  it  is  usually  by  the  blood  stream.  Here 
the  vena  cava  seemed  free,  but  we  are  by  no 
means  certain  as  to  the  condition  of  the  lungs, 
being  unable  to  examine  the  thorax  for  metas- 
tases. 

Only  a  partial  autopsy  was  permitted,  and 
that  of  necessity  a  hasty  one.  The  abdomen 
was  opened,  showing  a  meagre  panniculus. 
The  visible  coils  of  intestines  were  reddened 
and  the  transverse  colon  displaced  downwards 
and  to  the  left.  A  large  mass  was  found 
beneath  these  intestinal  1  »ops,  occupying  the 
umbilical  and  left  lumbar  regions  chiefly,  and 
reaching  for  about  one  inch  to  the  left  of  the 
vertebral  column.  This  was  discovered  to  be 
the  left  kidney  and  adrenal  converted  into  a 
large  tumor,  which  lay  partly  twisted  on  itself, 
so  tiiat  the  convex  border  of  the  kidney  lay 
rather  downwards  than  outwards.  The  tumor 
was  easily  and  rapidly  removed,  ///  toto.  there 
being  no  dense  attachments  to  any  neighbor- 
ing organs,  but  merely  tliin,  loose  adhesions. 

During  removal  it  was  observed  that  some  of 


THE   CANADA.   MEDICAL   RECORD. 


105 


the  retro-peritoneal  and  lumbar  glands  were 
involved,  and  that  a  thrombus  partially  filled 
the  renal  vein.  The  vena  cava  was  found  free 
as  far  as  could  be  asc^  rtained.  There  was  not 
enough  time  allowed  to  dissect  up  the  thoracic 
duct. 

The  tumor  on  removal  presented  a  large 
mass,  divided  at  the  junction  of  its  uppermo.st 
and  second  growth  into  two  unequal  parts. 
The  greater  and  lower  portion  had  the  usual 
renal  shape,  and  was  surmounted  r.t  its  upper 
end  by  the  remaining  ponion  of  the  tumour 
which,  as  it  were,  fi.tted  like  a  cap  on  top  of 
the  kidney. 

That  this  was  supra-renal  was  borne  out  by 
its  position  and  relation  to  the  kidney,  as  well 
as  by  the  fact  that  the  renal  capsule  could  be 
stripped  off  between  the  kidney  and  the  upper 
mass.  To  make  further  certain,  there  was  no 
other  evidence  to  be  found  of  adrenal  in  the 
neighborhood. 

The  adrenal  was,  however,  partly  joined  to 
the  kidney  by  several  areas  of  new  growth, 
these  being  the  channels  of  transmission  of  the 
growth  from  the  kidney  to  the  other  organ. 

On  removal  the  whole  mass  weighed  1250 
gram. 

Measurement  of  the  kidney  alone  was  7^ 
inches  long  by  5  inches  broad,  and  2  1 2  to  3  in 
thickness. 

Adrenal  alone  measured  4  inches  x  3  inches 
X  i}^. 

The  kidney  capsule  presented  numerous 
dilated  lymphatics  filled  with  granular  material, 
and  was  fairly  easily  stripped  from  the  organ. 

Section  into  the  kidney  showed  that  but  little 
renal  tissue  remained,  the  cortex  in  the  upper 
half  being  about  half  its  normal  thickness  and 
less,  and  in  some  places  so  thin  that  the  con- 
tents of  the  tumor  were  almost  protruding. 
In  the  lower  portion,  however,  not  only  was 
the  cortex  about  the  normal  size,  but  there  was 
further  some  evidence  of  medullary  pyramids 
and  calices.  The  hollowed  out  areas  thus  left 
were  filled  with  a  large  quantity  of  cheesy  look- 
ing pultaceous  material,  composed  of  fatty  cells 
and  free  fat  globules,  granular  detritus,  choles- 
terine  cells  and  remains  of  old  haemorrhages. 
The  pelvis  of  the  kidney  and  upper  part  of  the 
ureter  were  filled  with  the  same  mass  of  degen- 
erated cancerous  material,  and  the  renal  vein 
showed  the  presence  of  a  cancerous  thrombus 
along  nearly  its  whole  course. 

The  adrenal  was  similarly  affected,  and  its 
outer  covering,  which  was  greatly  thickened, 
formed  a  kind  of  capsule  to  the  enclosed  mass 
of  detritus,  resulting  from  the  retrograde 
changes  and  haemorrhages  within  of  the  can- 
cer which  had  involved  this  organ  in  virtue  of 
its  contiguity. 

Microscopic  examination  oi  \.\\t  remnants  of 
kidney  tissue  showed  masses  of  columnar  and 
polyhedral  small  cells  of  epithelial  character. 


distributed  \\\  \aiious  portions  and  situated 
amid  a  fibrous  stroma.  In  many  places  very 
little  evidence  of  tubules  could  be  found,  the 
whole  renal  tissue  being  overrun  by  the  neo- 
plasm. Where,  however,  tubules  or  glomeruli 
could  be  found,  it  was  evident  that  from  here 
the  growth  had  taken  its  origin,  while  the 
fibrous  stroma  arose  from  intertubular  connec- 
tive tissue. 

Sections  of  the  involved  .suprarenal  showed 
the  walls  densely  infiltrated  with  cancerous 
tissue,  so  much  so,  that  there  was  but  little 
evidence  of  the  original  normal   adrenal  tissue. 

Secondary  Enchotidroma  in  a  Bitch. — Dr. 
Adami  eighteen  months  ago  had  exhibited 
before  this  Society  the  rare  condition  of  an  en- 
chondroma  of  the  mammary  gland  occurring  in 
a  bitch.  The  animal,  after  its  removal,  kept  in 
very  fair  condition  for  some  time  ;  but  towards 
the  end  of  February  last,  a  swelling  was  noticed 
ill  the  abdominal  cavity,  which  was  thought  to 
be  of  an  obstetrical  nature.  It,  however,  con- 
tinued to  grow,  extending  in  a  rather  trans- 
verse direction.  There  was  gradually  increas- 
ing difficulty  of  locomotion,  and  about  three 
weeks  ago  the  animal  was  killed  in  the  labora- 
tory and  a  post  mortem  performed.  A  hard 
tumor  was  found  in  the  abdomen  attached  to 
the  mesentery;  it  was  not  adherent  to  any  of 
the  abdominal  viscera,  except  a  portion  of  the 
liver,  which  was  found  separated  from  the  rest 
of  that  organ.  Examination  showed  it  to  be 
an  enchondroma,  hard  at  the  edges^  with  bony 
matter  scattered  here  and  there  ;  while  the 
whole  central  portion  was  essentially  myxoma"- 
tous.  It  appeared  to  be  attached  to  the  me- 
sentery and  to  have  started  there  ;  but  we  had 
then  these  peculiar  relations  between  the 
tumor  and  the  liver  to  explain,  and  altogether 
it  seemed  more  reasonable  to  conclude  that 
the  growth  commenced  in  the  liver,  extended 
until  its  weight  caused  that  part  of  the  organ 
which  contained  it  to  break  off  from  the  rest, 
and  then  attached  itself  to  the  mesentery. 
The  tumor  weighed  ten  pounds,  while  the 
animal  in  health  did  not  weigh  more  than 
twenty  pounds,  and  probably  something  less 
than  that  at  the  time  of  the  autopsy,  as  it  was 
much  wasted.  In  addition  to  this  large  mass, 
other  secondary  gi'owlhs  were  seen  in  the 
form  of  cartilaginous  nodules  in  various  por- 
tions of  the  lungs,  pancreas,  abdominal  glands 
and  kidney.  Dr.  Adami  regarded  the  case  and 
sj^ecimen  as  interesting,  first,  because  the  con- 
dition of  primary  enchondroma  of  the  mam- 
mary gland  is  a  very  rare  one ;  secondly, 
because,  in  spite  of  the  usual  benign  character, 
in  this  case  it  had  been  followed  by  secondary 
growths. 

Dr.  Mills'  experience  of  tumors  in  dogs 
led  him  to  believe  that  any  kind  of  a  growth 
occurring  in  the  mammary  glands  of  dogs  is 
apt  to  be  followed  by  secondary  growths.     He 


io6 


THE  CANADA  MEDICAL  RECORD. 


had  had  quite  d  number  of  these  tumors  ex- 
amined microscopically,  and  then,  in  spile  of 
their  benign  gross  appearance,  sarcomatous 
tissue  was  i)reity  generally  found  in  them. 

The  Late  Dr.  E.  A.  McGannon.—'\\\Q  fol- 
lowing resolution  was  moved  by  Dr.  J.  Alex. 
HuTCHLSON,  seconded  by  Dr.  J.  J.  Gardner  : 

i^t'j(?/7ra'.-— That  this  Society  learns  with 
feelings  of  sincere  sorrow  of  the  death,  at  the 
early  age  of  41  years,  of  Dr.  Edward  Aaron 
McGannon,  of  Brockville,  Ontario. 

A  member  of  this  Society  since  1889,  he 
attended  its  meetings,  contributing  papers  and 
entering  into  the  discussions. 

He  was  one  of  the  few  members  residing  at 
a  distance  from  the  city  who  took  an  active 
interest  in  its  deliberations. 

His  genial  disposition  and  kindly  manner 
made  him  the  friend  of  all. 

SOCIETE    FRANQAISE    DE    LARYNGO- 

LOGIE,   D'OTOLOGIE,    ET  DE  RHI- 

NOLOGIE. 

Primary  Laryngeal  'I'uberculosis  Ac- 
quired BY  Cohabitation, — M.  Cadier,  of 
Paris,  reported  several  cases  in  which  examina- 
tion had  demonstrated  the  fad  that  phthisis 
acquired  by  cohabitation  begins  oftenest  in  the 
upper  portions  of  the  larynx  (the  ventricular 
bands,  the  upper  surface  of  the  vocal  cords,  and 
the  interarytenoid  space).  In  the  majority  of 
cases  the  lesions  lemain  for  some  time  localized 
in  the  larynx,  and  may  be  diagnosed  by  an  atten- 
tive laryngoscopical  examination,  while  their 
progress  may  be  arrested  by  topical  applications 
and  cauterization.  It  is  indispensable,  how- 
ever, to  begin  treatment  as  soon  as  possible 
after  the  turberculous  inoculation  has  taken 
place. 

Results  of  Castration  upon  the  Female 
Voice. — .\1.  Moure,  of  Bordeaux,  called  atten- 
tion to  the  consequence  of  ablation  of  the  tes- 
ticles in  man  and  the  physiological  relations 
existing  between  the  genital  organs  and  the 
larynx.  He  reported  two  cases  of  women  who 
had  submitted  to  ovarian  castration,  and  who 
showed  a  marked  lowering  of  the  timbre  of  the 
•voice,  which  at  the  same  time  became  much 
stronger.  He  believed,  however,  that  these 
changes  were  not  constant,  and  that  it  was  not 
easy  to  recognize  them  when  they  did  occur, 
except  in  singers,  and  especially  high  sopranos. 
It  is  known  that  after  a  certain  age  the  removal 
of  ovaries  or  testicles  has  no  effect  ujjon  the 
XdiXyvw.—SeiiiavuMcuffcale,  May  12,  1894. 

Intubation  ok  the  Larynx. — Dr.  Bonain, 
of  Brest,  described  iheinstruments  invented  by 
O'Dwyer,  and  insisted  ui)on  the  importance  of 
possessing  these  tubes,  which  he  regarded  as 
-faultless.  He  had  used  them  in  23  cases  of 
croup,  21  following  diphtheria  of  the  pharynx, 
and  2  without  apparent  diphtheria  in  which  the 


diagnosis  was  confirmed  by  bacteriologica 
examination  of  the  false  membrane.  In  one  of 
the  latter  case=,  a  child  of  1 1  month';,  recovery 
ensued  when  the  tube  had  been  in  the  larynx 
eleven  days.  There  were  7  cases  of  recovery  in 
children  ftom  20  mouths  to  10  years.  .According 
to  ^L  Bonain,  intubation  presents  the  following 
advantages:  i.  The  simplicity  of  the  operation, 
its  rapidity,  and  the  fact  that  it  is  readily  ac- 
cepted by  iheparenis,  requiring  no  special  assis- 
tance and  thatitcan  be  done  in  any  surroundings. 
2.  The  expulsive  force  of  the  cough,  considerable 
when  O'Dwyer's  tube  is  used,  which  insures 
better  drainage  of  the  trachea  and  bronchi.  3. 
The  rarity  of  pulmonary  complications.  4. 
The  bloodless  character  of  the  operation,  pre- 
venting enfeeblement  of  the  patient,  especia!ty 
the  very  young.  5.  The  fact  that  the  patient 
can  express  his  needs  and  wishes  in  a  low  voice. 
6.  The  simplicity  of  the  after-treatment,  con- 
sisting only  of  alimentation  and  waiching  of  the 
patient.  7.  The  rapid  convalescence,  without 
cicatrice  of  the  neck.  S.  The  fact  that  the 
child  is  not  obliged,  as  is  sometimes  the  case 
after  tracheotomy,  to  wear  a  canula  for  some 
time, — a  permanent  danger  to  the  lungs. 

Outside  of  diphtheria,  intubation  may  gener- 
ally replace  tracheotomy  in  acute  or  chronic 
stenosis  of  the  larynx,  due  10  tertiary  syphilis 
or  tuberculosis,  in  subglot'.ic  laryngitis,  and  in 
burns  and  fractures  of  the  larynx. — Medecitie 
Modernc,  May  5,  1894. 

Treatment  of  Epistaxis. — Dr.  C.  Miot, 
in  discussing  this  subject,  stated  that  positive 
interstitial  electrolysis  should  be  the  method  of 
choice  when  extensive  epistaxis  occurred  from 
erectile  or  varicose  tissue.  It  was  also  of  value 
in  the  treatment  of  more  limited  hosinorrhagic 
areas.  Electrodes  of  copper  or  silver  were  pre- 
ferable. The  intensity  of  the  current  should 
average  from  16  to  20  milliamperes,  and  the 
length  of  the  seance  from  eight  to  ten  minutes. 
Three  or  four  applications  were  sufficient  in  ex- 
ceptional cases,  one  or  two  in  ordinary  instances. 
Hgemostasis  in  this  region  is  easily  secured, 
although  its  vascular  relations  with  the  brain  are 
important. — Revue  dc  Laryn^^^ologie,  Jluic  i, 
1894. 

AMERICAN  ASSOCIATION  OF  GENITO 
URINARY  SURGEONS. 
Enlargement  ok  the  Prostate. — Dr. 
George  Chismore,  of  San  Francisco,  read 
a  paper  on  a  *'  Modificuion  of  Bigelow's 
Operation  for  Stone  in  the  Bladder,  Designed 
to  Meet  Cases  in  which  the  Prostate  is  En- 
larged." He  called  attention  to  the  difference 
in  the  conditions  present  in  the  cases  com- 
plicated by  prostatic  enlargement,  to  the 
intolerance  of  such  patients  to  prolonged 
dperative  procedures  and  to  trauma  of  the 
bladder.  He  advocated  (1)  local  in  prefer- 
ence to  general  anaesthesia  ;  (2)  short  sittings; 


THE  CANADA  MEDICAL  RECORD. 


to7 


(3)  removal  of  any  remaining  fragments  after 
the  patient  has  fully  recovered  from  the  effects 
of  the  previous  operation,  and  as  soon  as  such 
fragments  can  be  detected  with  the  vesical 
sound.  His  procedure  is  as  follows  :  The 
bladder  is  emptied,  and  from-  i  to  2  ounces 
(30  to  60  grammes)  of  a  4-per-cent.  solution 
of  cocaine  hydrochlorate  are  injected.  The 
iithotrite  should  be  introduced  as  carefully  as 
possible,  and  if  spasm  is  present,  a  short  jiause 
should  be  made  rather  than  force  the  instru- 
ment in  the  face  of  this  obstruction.  As  soon 
as  the  stone  is  found,  it  should  be  crushed  as 
rapidly  as  possible,  but  no  prolonged  search 
should  be  made  for  remaining  fragments,  as 
this  adds  every  considerably  to  the  gravity  of 
the  operation.  Any  evacuator  may  be  em- 
ployed, but  Dr.  Chismore  employs  a  very 
simple  one  devised  by  himself.  Usually  there 
are  no  after-symptoms,  and  the  patient  feels 
relieved  at  once.  Occasionally  there  is  some 
swelling  of  the  deep  urethra.  If  any  frag- 
ments are  left,  the  old  symptoms  gradually 
return.  The  operation  of  crushing  these  frag- 
ments may  be  done  without  anae-thesia.  Dr. 
Chismore  still  employs  Bigelow's  instrument 
in  cases  of  hard  calculi,  as  his  instrument  does 
not  possess  the  strength  requisite  for  crushing 
such  stones.  He  maintained  that  in  all  cases 
of  vesical  calculus,  complicated  by  enlarge- 
ment of  the  prostate,  the  operation  described 
offers  every  prospect  of  success,  and  that  any 
stone  which  could  be  removed  by  perineal 
lithotomy  may  be  crushed  with  less  suffering 
and  with  greater  success  by  this  method. 

Dr.  J.  William  White  called  actention  to  the 
gravity  attending  the  use  of  a  general 
anaesthetic  in  many  of  these  cases,  the  effect 
of  which  was  to  cause  congestion  or  actual 
inflammation  of  the  already-crippled  kidneys. 
When  the  integrity  of  the  kidneys  is  open  to 
question,  he  thought  the  method  described 
would  occupy  an  important  place. 

Dr.  Francis  Watson,  of  Boston,  was  inclined 
to  consider  the  method  a  retrogression.  The 
higher  mortality  of  lithotrity  over  litholapaxy 
is  due  to  the  retention  of  the  crushed  frag- 
ments, and  he  was  unable  to  see  how  the 
same  injurious  effect  could  fail  to  follow  Dr. 
Chismore's  method  if  some  fragments  were 
removed.  He  was,  however,  most  favorably 
impressed  with  the  statistics  given,  and 
theoretical  objections  must  be  withdrawn  when 
such  a  good  showing  can  be  made.  Dr. 
Watson  advocated,  ui  the  class  of  cases  alluded 
to,  the  method  so  strongly  indorsed  by 
Reginald  Harrison,  of  performing  perineal 
cystotomy  and  crushing  and  evacuating  by 
this  route. 

Dr.  William  K.  Otis,  of  New  York,  favored 
supra-pubic  lithotomy  in  cases  of  stone  in  the 
bladder,  in  the  presence  of  considerable 
enlargement   of  the    prostate   gland,    as    this 


operation  gives  an  opportunity  to  inspect  the 
bladder  and  provides  ibr  drainage.  In  many 
cases,  however,  he  thought  Dr.  Chismore's 
method  would  be  very  suitable. 

Dr.  John  P.  Bryson  said  he  employed 
the  cystoscope  with  advantage  in  gain- 
ing definite  information  of  the  exact  intra- 
vesical conditions  present.  Local  anaesthesia 
is  coming  more  and  more  into  use,  and  in  many  . 
instances  is  exceedingly  satisfactory,  while 
general  anaesthetics  are  in  many  cases  danger- 
ous. Most  fatal  cases  are  due  to  traumatism 
of  the  prostatic  urethra. 

Dr.  James  Bell  preferred  the  supra- pubic 
operation  for  stone  in  prostatic  cases.  He 
was  struck  by  the  large  amount  of  cocaine 
employed  by  Dr.  Chismore,  and  that,  as  stated 
by  tne  latter,  no  symptoms  causing  anxiety 
had  appeared. 

Some  Infrequent  Symptoms  of  Disease  of 
THE  Urinary  Tragi-. — Dr.  Alexander  W^. 
Stein,  of  New  York,  referred  to  cases  of 
membranous  casts  from  the  bladder  and 
urethra.  The  cause  usually  given  is  retention 
of  urine.  Of  50  reported  cases,  45  were  in 
women  and  5  in  men.-  The  causes  of  retention 
in  the  females  were  either  a  retroverted  uterus 
or  pressure  of  the  child's  head  during  pro- 
longed parturition.  The  prognosis  is  usually 
good  ;  of  45  case3j  but  9  terminated  fatally. 
The  case  was  reported  of  a  man,  26  years 
old,  who  had  frequent  attacks  of  renal  colic 
on  the  left  side,  and  who  on  one  occasion  had 
retention  for  twenty -four  hours  ;  finally  he  pas- 
sed a  stone  per  urethrain  with  relief  of  the 
retention.  The  attacks  cf  renal  colic  continu- 
ed. Later,  he  was  subjected  to  litholapaxy 
for  stone  in  the  bladder.  Still  later,  he  began 
to  pass  "  fleshy  "  masses  of  large  size.  The 
urine  was  loaded  with  pus,  and  was  offensive. 
Improvement  followed  antiseptic  irrigations 
of  the  bladder.  The  patient  was  lost  to 
observation,  and  it  was  reported  that  he  after- 
wards died.  The  cause  of  death  could  not  be 
learned,  but,  as  the  termination  was  preceded 
by  stupor,  it  was  possibly  urfB.nia. — Medical 
JYezus,  June  2,  1894. 

BRITISH   MEDICAL  ASSOCIATION. 

Operative  Treatment  of  G.a.stric  and 
Typhoid  Ulcers  Associated  with  Perfor- 
ation — Mr.  A.  Pearce  Gould,  in  opening  a 
discussion  on  this  subject,  stated  that  the  path- 
ology of  the  perforating  ulcer  of  the  stomach 
and  duodenum  was  still  obscure.  It  was  com- 
mon in  young  and  antemic  wom=n  of  the  ser- 
vant class,  and  also  in  middle-aged  men.  It 
was  usually  single,  and  situated  on  the  lesser, 
and  very  rarely  on  the  greater,  curvature  of  the 
stomach.  Its  size  was  tliat  of  a  sixpence  or  a 
shilling ;  it    was   of  variable  depth,    the   floor 


io8 


THE  CANADA   MEDICAL    RECORD. 


being  formed  either  of  peritoneum  or  possibly 
of  a  thickened  area,  up  to  the  size  of  the  i^alm 
of  the  hand.  'I'he  symptoms  for  the  most 
part  were  agonizing  pain  after  eating,  frequent 
vomiting,  hcxmatemesis,  and  mela^na.  At  times 
the  patient  made  no  complaint,  and  was  una- 
w^are  of  suffering  any  departure  from  heahh. 
In  truth,  the  symptoms  were  no  sure  guide  to 
the  extent  of  the  disease.  In  the  majority  of 
cases  cicatrization  took  phice,  although  in  25 
per  cent,  perforation  occurred.  In  85  per 
cent,  the  perforation  was  on  the  anterior  aspect 
of  the  organ  opening  into  the  peritoneal  cavity. 
Young  sirvant-girls  were  especially  prone  to 
anterior  perforation.  He  disapproved  of  Bill- 
roth's  recommendaiion  of  timely  laparotomy, 
excision  of  the  ulcer,  and  suture  of  the  wound, 
unless  it  was  possible  to  establish  an  exact 
diagnosis.  'J'he  surgeon's  duly  consisted  in 
tlie  prevention  or  arrest  of  peritonitis.  The 
only  hope  of  doing  good  lay  in  cleansing  the 
peritoneal  cavity.  Hitherto  too  much  stress 
had  been  laid  on  suturing  the  rent  in  the  stom- 
ach and  too  little  on  cleansing  the  peritoneum. 
The  following  measures  should  be  adopted : 
(i)  simple  washing  out  of  ihe  abdominal  cavity  ; 
(2)  suture  of  the  ulcer  ;  and  (3)  where  that 
was  impossible,  suture  of  the  stomach  to  the 
abdominal  parietes.  But  he  could  not  too 
often  repeat  that  the  success  of  these  cases 
depended  upon  cleansing  the  peritoneum. 

Experience  a'one  could  decide  the  precise 
period  when  the  <  peration  should  be  performed. 
If  too  long  a  time  were  allowed  to  elapse,  the 
peritonitis  became  general  and  intensified. 
Moreover,  under  these  circumstances,  masses  of 
lymph  concealed  the  aflFected  parts  and  inter- 
fered with  the  cleansing  of  the  sac.  The  best 
site  for,;  the  incision  was  in  the  middle  line,  as 
this  gave  the  best  access  to  the  whole  of  the 
abdomen,  while  the  seat  of  pain  was  no  guide 
to  localization.  First  among  the  fluids  used 
for  flushing  he  placed  normal  salt-solution,  and 
then  boiled  water.  He  avoided  acid  or  toxic 
solutions,  and  used  the  water  hot,  as  he  found 
it  a  powerful  restoiaiive.  A  vital  step  was  the 
systematic  flushing  with  a  large  exit-tube  ; 
where  j^raclicable  he  sewed  up  the  ulcer,  but 
attributed  no  particular  advantage  to  paring  or 
excising  the  ulcer.  The  stomach  might  or 
might  not  be  washed  out.  The  value  of  explor- 
ation with  the  finger  was  doubtful.  When  in 
doubt,  drainage  should  be  resorted  to.  If  the 
collapse  were  not  relieved  by  hot  water,  he 
practised  intra-venous  injection.  He  read  the 
notes  of  six  successful  cases  of  operation  in  per- 
forating gastric  ulcer.  With  regard  to  perfor- 
ation in  typhoid  ulcers'  he  had  collected,  ex- 
cluding doubiful  cases,  seventeen  cases  of  oper- 
ation with  one  recovery.  The  steps  of  the 
operation  were  the  same  as  those  for  gastric 
ulcer.  Statistics  show  that  theie  were  from  25 
to   3  per   cent,  of  perforation   in   all  cases  of 


typhoid  fever — most  frequently  occurring  in 
the  ileum,  often  multiple,  sometimes  so  small 
as  to  allow  no  escape  of  intestinal  contents. 
They  usually  took  place  during  the  third  week, 
but  cases  were  known  as  late  a-)  the  sixty-sixth 
day.  The  symptoms  may  be  very  marked  or 
quite  latent.  Death  may  close  the  scene  in  ten 
minutes;  the  patient  rarely  survives  more 
than  two  days.  Recover}^  was  exceedingly 
rare.  He  concluded  by  saying  that  the  truest 
wisdom  was  the  wise  selection  of  cases. 

Dr.  R.  Maclaren,  of  Carlisle,  in  operating 
for  gastric  ulcer,  preferred  to  make  his  incision 
in  the  left  linea  semilunaris,  four  inches  in 
length,  which  allowed  good  access  to  the  stom- 
ach. He  emphasized  the  point  that  cleansing 
of  the  peritoneum  was  all  important.  Tlie  con- 
ditions of  success  were  system,  perseverance, 
and  a  patient  not  on  the  verge  of  death  from 
collapse.  A  detail  of  much  importance  in  after- 
treatment  was  rectal  feeding.  Again,  if  the 
I  aiient  were  much  collapsed,  he  did  not  be- 
lieve much  in  flushing.  He  described  fully  his 
method  of  cleansing  the  peritoneal  cavity.  In 
his  opinion,  the  operative  procedures  in  these 
cases  were  troublesome  rather  than  difiicult. 
For  example,  if  the  intestines  were  distended, 
more  difticuUy  was  experienced.  Great  mor- 
tality was,  however,  only  to  be  expected.  He 
mentioned  a  case,  in  which  he  had  the  advice 
of  Dr.  Heron  Watson,  where  perforation  occur- 
red in  connection  with  a  typhoid  ulcer.  The 
only  treatment  adopted  was  that  of  making  an 
incision  over  the  CKcal  region  and  inseiting  a 
drainage-tube.  The  patient,  although  desper- 
ately ill  for  some  time  afterward,  made  an  ex- 
cellent recovery. 

Mr.  Rutherford  Morison,  of  Newcastle,  re- 
lated a  case  in  which  he  had  operated  for  gas- 
tric ulcer  on  a  woman  of  23.  She  had  iiad  a 
large  quantity  of  bread  and  milk  for  her  supper, 
and  one  hour  afterward  was  suddenly  seized 
with  acute  pain.  On  examination  the  diagno- 
sis was  arrived  at  of  gastric  perforation,  but 
one  of  the  chief  symptoms  preser.t  was  dullness 
in  the  flanks.  The  collapse  was  extreme.  Two 
hours  afterward  the  abdomen  was  opened  in 
the  middle  line  over  the  stomach  and  the 
omentum  torn  through,  when  a  large  quantity 
of  fluid  escaped,  and  an  ulcer  was  tound  on  the 
l)osterior  wall  of  the  stomach.  Lembert's 
sutures  were  used.  I  he  abdomen  was  flushed 
out.  The  patient  did  well  lor  five  days,  al- 
though there  was  great  difliculty  in  managing 
her.  Uliiniately,  however,  she  became  very 
restless,  passed  into  a  collapsed  condition,  and 
died  on  the  ninth  day.  He  thought  that  the 
collapse  at  the  time  of  operation  in  these  cases 
was  relieved  by  the  operation  and  flushing  of 
the  abdomen.  \\'hen  the  j)atient,  however,  was 
'livid,  any  operation  was  certainly  contra-indi- 
cated. 

Mr.  Gilbert  Barling  thought  that  some  of  the 


THE   CANADA   MEDICAL   RECORD. 


109 


expressions  of  opinion  with  respect  to  these 
cases  were  too  optimistic,  especially  so  in  re- 
gard to  typhoid  nlcers.  His  experience  was 
limited  to  five  cases.  In  three  of  these  he 
operated  ;  in  the  fourth  he  regretted  that  he 
had  not  operated,  and  in  the  fifth  the  patient 
vomited  pus  and  passed  a  large  quantity  of  pus 
per  anum,  but  after  a  perilous  time  uliimately 
recovered.  In  one  of  the  cases  upon  which 
he  had  operated,  recovery  followed.  He  agreed 
that  the  less  done  in  perforating  typhoid  ulcers 
tiie  better. — Lancet,  August  4,  1894. 

ASSOCIATION    OF   AMERICAN   PHYSI- 
CIANS. 

Treatment  op  Certain  Symptoms  of 
Croupous  Pneumonia,  Particularly  in 
Adults. — Dr.  Beverley  Robinson,  of  New 
York,  laid  special  stress  upon  the  management 
of  two  symptoms  of  the  first  stage  of  the  dis- 
ease, namely,  pyrexia  and  pulmonary  conges- 
tion. He  doe?  not  use  the  modern  antipyretics, 
"except  in  special  cases.  Phenacetin  he  regards 
as  the  best  of  the-se,  for  the  reason  that  in  addi- 
tion to  its  antipyretic  action  it  also  induces 
sleep.  The  spirit  of  mindererus,  potassium 
citrate,  and  magnesium  sulphate  he  uses  largely. 
Quinine,  in  doses  of  2  to  4  grains  (0.T3  to  0.26 
gramme)  every  three  hours,  is  antipyretic. 
Cold  sponging  and  cool  baths  are  not  especially 
efficacious  ;  if  the  temperature  of  the  patient 
is  over  104°  F.  (4o°C.),  and  the  pulse  is  rapid 
and  delirium  is  present,  a  tub-bath  may  be  ad- 
vantageously employed.  He  has  seen  bad 
results,  howeve--,  following  immersion  in  a  tub- 
bath  ;  sponging,  with  friction,  is  preferable. 
The  advantage  of  the  bed-bath  is  the  avoidance 
of  shock  and  exposure,  and  the  ease  with  which 
it  can  be  given.  The  bath  should  last  fiom 
fifteen  to  thirty  minutes,  and  is  to  be  repeated 
whenever  the  temperature  is  over  103°  F. 
(39-5°  Ci.)  ;  prompt  relief  follows,  the  temper- 
ature falhng  to  100°  F.  (37.8°  C). 

Aconite  and  aconitine  act  by  diminishing  he 
heart's  action  through  its  motor  ganglia.  The 
heart  is  slowed  in  a  very  alarming  manner,  and 
may  be  arrested  in  diastole;  i -150th  grain 
(0.0C043  gramme)  of  aconitine  may  produce 
serious  results  ;  hence  he  does  not  believe  in 
its  uses.  The  administration  of  small  and  re- 
peated doses  of  antimony  oxysulphuret,  i-32n  1 
grain  (0.002  gramme),  every  hour  or  two  hours, 
IS  much  superior  to  the  use  of  aconite.  It  ren- 
ders the  sputum  more  fluid,  and  therefore  easier 
of  expectoration,  and  in  this  way  diminishes 
the  dyspncea.  It  is  also  well  borne  by  the 
aged  and  by  children.  It  may  be  used  in  both 
the  first  and  second  stages  of  the  disease. 
Nitroglycerin,  by  the  mouth,  or,  better,  hypo- 
dermatically,  in  doses  of  i-5oth  or  i-25th  grain 
(0.013  or  0,0026  gramme),  is  an  excellent 
remedy  in  this  disease.  It  strengthens  the 
weak  pulse,  removes  [the  cyanosis   and  relieves 


the  dyspncea.  Inhalations  of  oxygen  in  pneu- 
monia usually  give  relief,  but  in  some  instances 
the  dyspnoea  is  increased  by  its  use.  Especi- 
ally in  cases  of  general  oedema  have  unfavor- 
able results  been  noted.  In  favor  of  the  right 
heart  inhalations  are,  according  to  some  au- 
thorities, of  marked  service,  though  the  subject 
is  still  open  for  discussion.  'I'he  abundant 
use  of  cold  spring-water,  Apollinaris,  and  other 
table  waters  is  of  service  in  promoting  diuresis 
and  diaphoresis,  and  in  this  way  reducing  the 
abnormal  temperature  of  the  body.  Alcohol 
is  beneficial  in  many  cases,  not  only  on  ac- 
count of  its  nutritive  value,  but  also  because  it 
aids  the  respiratory  function.  It  also  gives 
nerve-force,  controlhng  the  adynamia  and  ner- 
vousness. There  are  only  two  contra-indications 
to  its  employment,  namely,  when  the  patient  is 
plethoric  and  when  there  is  hepatic  engorge- 
ment and  gastric  catarrh.  In  these  cases, 
small  and  repeated  doses  of  calomel  will  act 
in  the  most  beneficial  manner.  Digitalis  or 
digitalin  in  small  doses  may  be  given  to  con- 
trol an  irregular  heart  ;  otherwise  either  is  not 
to  be  used,  on  account  of  inducing  vascular 
contraction.  Strychine  by  the  mouth  or  hypo- 
dermatically,  from  i-3oth  to  i-i6th  grain  (0.002 
to  o.oo4gramme),is  a  very  useful  drug  ;  at  times, 
however,  it  may  produce  nervous  irritability. 
Nitroglycerin  acts  by  bleeding  from  the  veins 
into  the  arteries,  in  this  way  taking  the  place 
of  the  old  method  of  bleeding,  which  was  often 
followed  by  excellent  temporary  results.  In 
cases  of  threatened  heart-clot,  venesection,  fol- 
lowed by  injections  of  salt-solution,  may  yield 
excellent  results.  Black  coffee  is  of  service 
when  other  remedies  cannot  be  borne  by  the 
stomach,  and  may  tide  the  patient  over.  Caf- 
feine does  not  replace  the  use  of  coffee,  for  the 
reason  that  it  is  merely  an  alkaloid,  and  does 
not  possess  the  nutritive    value  of  the  coffee. 

Dr.  Peabody,  of  New  York,  remarked  that 
pain,  with  insomnia  and  cough,  is  an  urgent 
symptom  of  croupous  pneumonia,  that  could 
be  controlled  by  the  use  of  small  doses  of  mor- 
phine hypodermatically,  as  grain  i-6th  (o.oi 
gramme)  repeated  once  or  twice  during  the 
night.  He  objects  to  the  too  frequent  use  of 
water  in  reducing  the  temperature.  He  has 
very  rarely  found  heart-clot  as  a,  pathological 
feature  in  this  disease,  and  believes  that  many 
of  the  so-called  cases  of  ante-mortem  clot  are 
in  fact  but  post-mortem  clots. 

Dr.  J.  C.  Wilson,  of  Philadelphia,  b  lieved 
that,  owing  to  the  varied  clinical  manifestations 
of  pneumonia,  the  treatment  must  be  largely 
expectant  and  symptomatic.  Cold  baths  have 
not  been  satisfactory  in  his  hands.  Local  ap- 
plications of  cold  to  the  chest  have  been  advan- 
tageous in  many  cases,  iw  sthenic  cases,  with 
delirium  and  other  nervous  manifestations, 
affusions  of  from  one-half  to  one  gallon  of  cold 
1  water,   poured  over  the    head  and    shoulders, 


no 


THE   CANADA   MEDICAL    RECORD. 


will  often  act  as  the  tuining-point  in  the  dis- 
ease. Venesection  proves  beneficial  in  many 
cases  of  pneumonia  by  attenuating  the  toxaemia 
and  removin:?  from  the  blood  a  quantity  of 
efleie  material.  He  indorses  the  use  of  small 
amounts  of  opium,  as,  e.j^'.,  2  or  3  griiins  (0.13 
or  0.2  gramme)  of  Dover's  powder,  for  from 
every  twoto  four  hours.  — O'/iiversa/  Medical 
Jotirnal. 

CONGRESS  OF  AMERICAN  PHY- 
SICIANS AND  SURGEONS. 
Sewer  Gas  as  a  cause  ok  Throat  Disease. 
— Dr.  Beverley  Robinson,  of  New  York, 
thought  it  was  a  demonstrated  fact  that  persons 
ill  with  diphtheria  became  more  severely  ill  if 
compelled  to  inhale  the  air  from  sewers  con- 
tinually. In  his  opinion,  if  a  person  with 
catarrh  of  the  throat  and  a  tendency  to  inflam- 
mation of  this  region  was  exposed  to  sewer-gas, 
he  would  be  liable  to  have  an  attack  of  inflam- 
mation. This  he  had  seen  time  and  again. 
The  house-physician  of  the  Willard  Parker 
Hospital  had  recently  informed  him  that,  not- 
withstanding the  large  number  of  cases  of 
diphtheria  in  that  hospital,  they  had  not  been 
able  to  find  the  Loefiler  bacihi  in  the  air  about 
the  patients.  It  had  recently  been  shown  that 
many  of  the  children  in  the  Hospital  for  the 
Ruptured  and  Cripjiled  had  been  going  around 
the  wards  with  the  Lceffler  bacilli  in  their 
throats,  without  showing  any  symptoms  of 
diphtheria. 

RECENT  SUGGESTIONS  IN  THERAPEU- 
TICS. 

Follicular  Tonsillitis. — If  seen  early  and 
no  complications,  Dr.  Sajou's  abortive  treat- 
ment,— anunoniated  tincture  of  guaic ,  i  tea- 
spoonful  every  two  hours  in  sweet  milk.  If 
seen  later,  calomel,  10  grains  (0.65  gramme)  ; 
soda  bicarb.,  20  grains  (1.3  grammes).  M.  ft. 
chart,  no.  iii.  One  every  three  hours  floating 
on  teaspoonful  of  water.  No  liquid  after  for 
twenty  minutes.  Follow  with  i  or  2  teaspoon- 
fuls  o{  castor  i?// with  10  to  15  drops  oi  turpcn- 
tins  tw^xy  hour  (for  first  12  hours)  excepting 
l»our  of  powders.  Gargle  and  swallow  tea- 
spoonful  of  saturated  solution  of  sulphate  of 
sodium  (C.  P.).  When  powders  are  finished 
and  worked  off"  by  castor-oil,  alternate  sodium 
sulphate  with  pot.  chlorat.,  i  drachm  (4 
grammes)  ;  amm07i.  jnur.,  i  drachm  (4 
grammes) ;  tifict.  ferri  mur.,  4  drachms  (16 
grammes)  ;  glyccriiii^  i  •_.  ounces  (46.5 
grammes)  ;  syr.  limonis,  2  ounces  (62 
grammes).  M.  Teaspoonful  as  a  gargle  and 
systemic  remedy.  Reduce  all  doses  for  chil- 
dren, anddispensewiih  gargles.  (C.  C.  Single, 
llierapcutic  Gazette,  ]une  15,  1894.) 

H.-v.MOKRHoiDS.  —  Cleanse  bowels  tiiorouyhly 
with  repeated  irrigations  of  salicylic-acid  solu- 
tion.    Introduce  into  the  rectum  a  suppository 


containing  2  grains  (0.13  gramme)  of  cocaine, 
and  from  ^  to  J 3  grain  (0.016  to  0.02  gramme) 
of  ;;/^/-//i/;/if,  about  15  minutes  before  opera- 
tion. If  patient  is  extremely  sensitive,  inject 
i-per-cent.  solution  of  cocaine  into  different 
portions  of  mucous  membrane  immediately 
before  operation.  Bring  tumors  into  view  by 
introducing  iodoform-gauze  tam.pon  through 
small  speculum.  Inject  saturated  solution  of 
iodoform  in  ether  into  cellular  tissue  adjoining 
each  nodule.  Injecting  on  both  sides  of  latter 
causes  formation  of  scar-tissue  and  shrinking 
of  circumvenous  tissue.  Now  substitute  sup- 
pository containing  2  grains  (0.13  gramme) 
salicylic  acid  for  gauze  tampon.  Give  bismuth 
and  opium  to  prevent  movement  of  bowels. 
On  third  day  inject  2  ounces  (62  grammes)  of 
olive  oil  wwo  rectum,  giving  castor-oil  per  os. 
During  subsequent  weeks,  bowels  should  be 
kept  loose.  Treatment  successful  in  eight 
cases.  (Carl  Beck,  Neiu  York  Medical  Jour- 
nal,}\!i\s  21,  1894.) 

Lemonade  for  Diabetics. — Pure  water ^ 
1000  grammes  (i  quart)  ;  pure  glycerin,  20  to 
30  grammes  (;<  to  i  ounce);  citric  acid,  5 
grammes  {1%  drachms).  To  be  taken  in 
small  quantities  within  twenty-four  hours. 
Journal  des  Fra-cticiens,  May,  1894.) 

Local  An.iisthetic  Solution. — Cocaini 
hydrochloride,  raorcin,  each  16  grains  (r.04 
grammes);  distilled  water,  -2  ounces  (62 
grammes).  Does  not  cause  systemic  distur- 
bances sometimes  produced  by  cocaine  alone. 
(J.  H.  Lowrey,  New  York  Medical  Journal, 
July  21,  1894') 

Lubrication  of  Catheters. — To  facilitate 
exploration  of  bladder  and  urethra  :  Powdered 
soap,  50  grammes  (rj/^  ounces)  \  glycerin  and 
■water,  each  25  grammes  (6)^  fluidrachms)  ; 
7nercicric  pefchloridc,  0.02  gramme  (J  3  grain). 
(Guyon,  Lancet,  July  28,  1894.) 

Malakine  in  Rheumatism. — Dose  in  acute 
articular  form,  6  grammes  (i^  drachms)  in 
twenty-four  hours.  As  much  as  10  grammes 
(2Yz  drachms)  may  be  given  without  danger  if 
doses  be  sufficiently  divided.  Increases  diur- 
esis, facilitates  elimination  of  uric  acid,  and 
lowers  temperature.  No  untoward  effects. 
(Montagnon  and  Dacher,  Loire  Medicate, ]\i\y 
15,  1S94.) 


lro(trc6S    of    §c«na. 


TORSION  OF  ARTERIES  FOR  THE 
ARREST  OF  HEMORRHAGE. 

Dr.  Claude  A.  Dundore,  of  Philadelphia,  in 
an  interesting  i)aper,  describes  this  method,  and 
credits  Amnsat  with  first  having  observed  the 
effect  of  torsion  of  arteries  in  arresting  hemorr- 
hage. 


THE  CANADA  MEDICAL   RECORD. 


Ill 


He  lias  used  torsion  in  113  cases  of  all  kinds, 
with  no  signs  of  secondary  hemorrhage,  and 
with  fewer  cases  of  delayed  tissue  unions.  He 
thinks  that  if  the  vessel  is  diseased,  that  torsion 
is  safer  than  the  ligature,  which  very  often,  even 
when  litde  force  is  exerted  in  tying,  partially 
or  entirely  severs  the  external  coat,  thus  by 
hastening  the  sloughing  of  the  end  of  the  ves- 
sel, tending  to  produce  secondary  hemorrhage. 
In  cases  of  diseased  vessels,  the  limited  method 
of  torsion  should  only  be  used,  and  the  end  of 
the  artery  should  not  be  rotated  more  than 
twice. 

In  plastic  operations,  the  fact  that  we  are 
enabled  to  close  the  wound  without  leaving  a. 
loop  of  catgut  to  irritate  or  produce  sepsis  and 
delay  union  is  an  advantage  which  cannot  be 
too  highly  appreciated. 

Doctor  D.  ends  his  paper  by  stating  that  ha 
is  satisfied  that  those  who  will  give  torsion  their 
practical  attention  will  be  amply  repaid  and 
thoroughly  convinced  that  as  an  agent  for  the 
averting  of  hemorrhage  it  is  the  equal,  if  not 
the  superior,  of  the  ligature  in  many  respects. — 
Internat.  Mid.  Magazine. 

A  NEW  TREATxMENT  FOR  HYDRO- 
CELE. 

A  new  treatment  for  hydrocele  is  proposed 
by  J.  Neumann  (^Wiener  Medizinisc he  P} esse, 
No.  45,  1893).  ^^  consists  in  the  withdrawal  of 
the  fluid  by  means  of  a  trocar  and  cannula, 
leaving  the  latter  in  the  hydrocele  sac  to  act 
as  a  drain.  A  slightly  compressing  bandage  is 
applied  over  a  small  thickness  of  cotton.  Heal- 
ing is  said  to  occur  in  a  few  days.  The  cannula 
is  removed  on  the  second  or  third  day. — North 
American  Practitioner. 

FREEDOM  FROM  RECURRING  APPEN- 
DICITIS AFTER  EVACUATION  OF 
THE  ABSCESS  AND  RETENTION  OF 
THE  APPENDIX. 

By  James  M.  Barton,  A.M.,  M.fJ., 

Sui^eon  to  the  Jefferson  Cvllege  Hospital  and 
to  the  Philadelphia  Hospital. 

[Philadelphia  Academy    of  Surgery.] 

At  the  last  meeting  of  the  American  Surgi- 
cal Association  I  reported  nine  recoveries  from 
operations  for  appendicitis  in  which  the  appen- 
dix was  not  removed.  These  were  all  cases  of 
ruptured  appendix  with  circumscribed  abscess, 
with  no  general  peritonitis  and  no  symptoms 
of  obstruction. 

The  operation  consisted  in  opening  the 
abdomen  and  using  sterilized  cheese-cloth  to 
hold  the  movable  intestines  back  and  to  pro- 
tect the  general  peritoneal  cavity  while  the 
abscess  was  opened  and  emptied.  Drains 
were  then  introduced,  some  of  the  cheese-cloth 
permitted  to  remain,  and  most  of  the  wound 


was    made    to    find   or 


closed.       No    attempt 
remove  the  appendix. 

Before  considering  the  later  condition  of  the 
appendix  in  these  cases,  I  wish  to  report, 
briefly,  five  more  cases  upon  whom  I  have 
operated  in  the  same  manner,  all  of  whom  also 
recovered. 

Mr.  B.,  aged  twenty-three  years,  a  patient 
of  Dr.  Cline,  of  Jersey  Shore,  Pa.  He  was 
operated  upon  August  24,  1893,  on  the  seven- 
teenth day  of  the  disease. 

William  C.  M.,  aged  twenty  years.  The 
operation  was  performed  at  Jefferson  College 
on  August  28,  1893,  on  the  third  day  of  the 
disease. 

Harry  S.,  also  aged  twenty  years.  I  per- 
formed the  operation  at  the  Philadelphia  Hos- 
pital, September  4,  1893,  on  the  seventh  day  of 
the  disease. 

Richard  B.,  aged  forty-four  years.  The 
operation  was  performed  at  the  Jefferson  Col- 
lege Hospital,  September  17,  1893.  It  was 
the  third  attack,  and  the  present  one  had 
exirted  for  thirteen  days. 

Miss  v.,  aged  twenty-two  years.  The 
operation  was  performed  November  10,  1893, 
on  the  third  day  of  the  disease.  She  was  a 
private  patient  of  Dr.  M.  B.  Dwight,  of  West 
Philadelphia. 

My  object  in  bringing  this  subject  to  your 
notice  is  to  exhibit  several  of  these  patients 
and  to  read  reports  from  most  of  the  others,  to 
show  that  none,  whose  histories  I  have  been 
able  to  follow,  have  been  at  all  troubled  by  the 
retained  appendix,  and  to  learn  if  the  expe- 
rience of  the  Fellows  of  the  Academy  have 
been  similar  to  my  own . 

It  is  becoming  widely  recognized  that  this 
method  of  operation  is  accompanied  by  a  low 
rate  of  mortality.  Richardson  in  this  country, 
Tait  in  England,  and  Reclus  and  Schmidt  on 
the  Continent,  as  well  as  many  others,  content 
themselves  in  these  cases  of  local  purulent 
peritonitis  with  protecting  the  peritoneal 
cavity  and  draining.  Others,  however,  still 
consider  that  no  operation  is  complete  without 
removing  the  appendix.  In  the  March  num- 
ber of  the  Annals  of  Surgery,  Fowler  advises, 
in  these  cases,  the  removal  of  as  much  of  the 
appendix  as  can  be  done  without  separating 
adhesions,  but  considers  it  necessary  to  remove 
the  rest  of  the  appendix  at  a  second  operation. 

Of  these  fourteen  cases,  eleven  were  oper- 
ated upon  by  myself  during  the  last  two  years. 
All  on  whom  I  have  operated  in  this  manner 
have  recovered,  and  none,  that  I  am  aware  of, 
have  had  any  trouble  with  the  retained  appen- 
dix since. 

As  the  mortality  has  been  much  greater 
when  I  have  removed  the  appendix,  I  now 
rarely  do  so  unless  the  appendix  is  unruptured, 
or,  if  ruptured,  only  when  general  peritonitis 
has  occurred. 


112 


THE   CANADA   MEDICAL    RECORD. 


Of  tliese  eleven  cases  I  have  been  able  to 
follow  the  history  of  eight,  several  of  whom 
are  here  to-night  for  examination. 

The  three  whom  I  have  not  been  able  to 
find  were  hospital  cases  ;  two  of  them  were 
brought  to  the  hospital  by  physicians.  If 
either  of  these  had  had  a  recurrence  needing 
surgical  aid,  I  should  probably  have   known  it. 

Of  the  eight  whose  histories  I  have  been  able 
to  follow,  none  have  had  the  slightest  symp- 
toms referable  to  the  appendix  since  the  opera- 
tion. No  tumor  is  to  be  felt  and  no  tender- 
ness. Indeed,  they  all  appear  to  have  been 
singularly  free  from  diseases  of  all  sorts  since 
the  operation. 

Mrs.  C,  aged  thirty  years,  is  here  this  even- 
ing, and  will  permit  us  to  examine  the  region 
operated  upon.  The  operation  was  performed 
November  29,  1892,  and  though  she  has  been 
using  the  sewing-machine  steadily  ever  since, 
she  has  enjoyed  the  most  robust  health.  The 
right  iliac  fossa  is  apparently  entirely  free  from 
disease. 

I  also  present  Wm.  C.  M.,  aged  twenty 
years.  I  operated  upon  him  at  Jefferson 
College  Hospital,  August  28,  1893.  He 
has  been  in  perfect  health  in  all  respects 
since  the  operation,  and  there  is  no  evidence 
of  disease  in  the  right  iliac  fossa. 

Harry  S.  has  also  been  kind  enough  to  come 
here.  I  operated  upon  him  September  4, 
189.^,  at  the  Philadelphia  Hospital.  He  also 
has  been  in  jjerfect  health  since  the  operation, 
and  presents  no  evidence  of  disease  anywhere. 

Dr.  Marshall,  of  Milford,  Delaware,  informed 
me  a  iew  days  ago  that  the  patient,  Mrs.  S., 
on  whom  I  o]^erated  for  him  on  February  26, 
1892,  has  erjoyed  perfect  health  ever  since, 
and  that  on  examination  he  has  been  unable 
to  find  any  tenderness  on  pressure  or  any 
tumor  in  the  right  iiiac  fossa. 

Dr.  Beary,  of  the  Falls  of  Schuylkill,  rep,oris 
that  Mrs.  K.  T.,  on  whom  I  operated  for  him, 
January  20,  1893,  has  been  in  perfect  health 
since  the  operation. 

Dr-.  Cline,  of  Jersey  Shore,  Pa.,  reports  that 
Mr.  B.    has   been  in  perfect  health  since  the 
operation;  indeed,  in  belter  health  than  for  a 
'ntnnber  of  years  before. 

Dr.  Dwight,  of  West  Philadelphia,  reports 
his  patient.  Miss  V.,  as  in  jjerfect  health  since 
the  opeiation,  and  on  a  recent  examination  of 
the  seat  of  the  disease  there  is  no  tenderness 
and  no  tumor  to  be  felt. 

1  )r.  Chandler,  of  Centreville,  Del.,  reports: 
"  1  he  patient,  Mrs.  M.,  on  whom  you  operated 
for  me,  April  3,  1893,  has  made  a  perfect 
recovery,  and  has  been  perfectly  well  ever 
since."  He  adds,  "  that  from  the  operations 
in  which  he  has  participated,  he  thinks  the 
removal  of  the  a])])endix  in  these  cases  is  not 
recjuired  if  good  drainage  is  established.  Tlie 
ai)pcndix  will  take  care  of  itself." 


From  the  uniformity  with  which  full  and 
complete  recovery  has  occurred  in  the  few 
cases  that  have  come  under  my  care,  it  looks 
as  though  the  appendix  is  not  very  liable  to 
give  trouble  if  permitted  to  remain.  Indeed, 
I  think  it  is  quite  hl^ely,  in  cases  such  as  we 
have  been  considering,  that  the  opening  from 
the  appendix  into  the  intestine  is  closed  early 
in  the  attack — closed  quite  as  firmly  as  any 
ligature  would  close  it,  and  there  is  but  little 
probability  that  fcecal  matters  will  ever  be  again 
able  to  enter  the  appendix,  either  to  cause  a 
faecal  fistula  to  follow  the  operation  or  to  start 
another  case  of  appendicitis  in  the  future. 

If  it  were  not  firmly  closed,  the  pus  would 
never  have  broken  through  the  walls  of  the 
appendix,  or,  having  broken  through,  the 
re^ilting  absccss  would  not  have  increased  in 
size,  but  would  have  emptied  itself  through  the 
appendix  into  the  bowel. 

To  further  illustrate  the  strength  of  this 
obstruction  at  the  base  of  the  appendix,  I  have 
observed,  in  several  cases  where  fcecal  fistula 
followed  appendicitis,  that  in  none  did  the 
fseces  make  their  exit  through  the  appendix,  but 
through  other  portions  of  the  intestines,  show- 
ing that  the  inflammatory  deposit  closing  the 
appendix  was  even  stronger  than  the  healthy 
bowel. 

The  mortality  following  operations  for 
appendicitis  is  mainly  due  to  general  septic 
peritonitis  and  to  intestinal  obstruction. 

If  we  lock  into  the  cavity  of  a  fully-devel- 
oped abscess,  such  as  we  have  been  consider- 
ing, we  can  readily  see  how  these  complica- 
tions may  follow  the  search  for  or  removal  of 
the  appendix.  The  cavity  of  the  abscess  is 
lined  with  a  thick  layer  of  grayish,  poorly 
organized,  aplastic  lymph,  filled  with  micro- 
or-ganisnis.  The  appendix  lies  buried  beneath 
this  lymph,  and  its  cavity  conmiunicates  freely 
with  the  general  abscess  cavity.  The  opening 
can  occasionally  be  seen,  and  is  often  the  only 
guide  by  which  the  position  of  the  appendix 
'   can  be  recognized. 

To  tear  up  this  fragile  and  infected  lymph, 
and  distribute  it  through  the  peritoneal  cavity 
while  searching  for  and  liberating  the  appen- 
dix, would  greatly  increase  the  probability  of 
establishing  a  general  septic  peritonitis. 

Intestinal  obstruction  following  operations 
for  appendicitis  is  probably  due  to  kinking  of 
the  recently  separated  intestines.  As  they 
reunite,  covered  and  stiffened  as  they  are  by 
inflammatory  deposits,  they  cannot  adjust 
themselves  as  readily  as  at  the  first  formation  of 
the  abscess. 

To  avoid  any  misunderstanding,  let  me  state 
that  it  is  only  in  ■  cases  of  circumscribed 
a,bscess  that  I  have  been  permitting  the  appen- 
dix to  remain. 

When  the  appendix  is  still  unruptured,  or 
when    it  has    ruptured    and  general  peritonitis 


THE  CANADA  MEDICAL  RECORD. 


113 


has  occurred,  or  when  obstruction  is  present, 
I  am  in  the  habi*.  of  removing  it. — Denver 
Medical  Times. 

BORIC-ACID  INJECTIONS  IN  GONORR- 

Ha:A. 

Chrzaszczevvski  has  had  good  results  from 
washing  out  the  urethra  in  the  various  stages  of 
this  disease  with  a  3  per-cent.  soUition  ofl)oric- 
acid  at  400  C.  (1040  F.).  He  ai)plied  it  by 
means  of  a  Nelaton  catheter  (9  to  1 1  Charrier's 
scale),  introduced  as  far  as  the  prostatic  part  of 
the  urethra,  injecting  a  portion  of  the  liquid,  and 
letting  it  run  out  slowly,  drawing  the  catheter 
out  three  to  six  centimetres,  and  again  injecting 
a  portion,  without  drawing  the  catheter  a  third 
time  a  similar  distance,  and  injecting  the  balance. 
Every  portion  injected  contains  100  grammes 
(3^  ounces)  of  solution,  'i'he  injections  should 
be  repeated  every  second  day. — Przeglad 
Lekarski,  No.   40,  1893. 

THE  EXTINCTION  OF  TUBERCULOSIS. 

Dr.  George  H.  1\ohe,  in  his  presidential 
address  before  the  Medical  &  Chirurgical 
Faculty  of  Maryland,  called  attention  to  the 
possibility  of  the  extinction  of  tuberculosis. 
He  considered  it  an  established  fact  that  with- 
out the  inoculation  of  the  bacillus  of  turbercu- 
losis  we  cannot  have  consumption  or  any  other 
form  of  turbercular  disease  ;  and  if  by  any 
means  this  infectious  agent  can  be  excluded 
from  the  body,  the  individual  is  safe  from  the 
disease.  The  principal  measures  to  accomplish 
thisend  must  comprise,  tirst,  immediate  destruc- 
tion of  the  bacillus  in  the  sputa  or  in  other  ex- 
cretions when  the  case  is  not  a  pulmonary  one; 
second,  the  disinfection  of  clothing  and  bedding, 
or  oiher  furniture  liable  to  be  contaminated 
with  the  infective  material.  Accessory  measures 
must  be  considered,  such  as  notification  of  the 
health  authorities  of  all  cases  of  consumption, 
public  disinfection  of  infected  houses  and  con- 
veyances, and  the  establishment  of  special  hos- 
pitals for  the  free  treatment  of  indigent  consump- 
tives established. 

The  efficient  carrying  out  of  restrictive  mea- 
sures against  consumption  requires  intelligent 
co-operation  on  the  part  of  the  public.  Hence, 
the  education  of  the  laity  upon  the  infectious 
nature  of  tuberculosis,  and  ihe  importance  of 
individual  measures  of  prophylaxis,  must  pre- 
cede any  successful  enforcement  of  legal  enact- 
ment looking  toward  the  restriction  of  the  dis- 
ease. There  can  be  no  doubt  that  the  public 
press  can  give  most  effective  aid  in  spreading 
such  knowledge.  It  is  the  most  powerful  aux- 
iliary of  the  sanitarian.  The  press  makes  pub- 
lic opinion.  Public  opinion  makes  laws,  and 
until  laws  have  the  sanction  of  public  opinion, 
it  is  futile  to  look  for  their  successful  enforce- 
ment. Popular  societies,  like  the  French  "  Ligue 


preventive  contre  la  phthisic  pulmonaire  "  and 
the  "  Pennsylvania  Society  for  the  Prevention  of 
Tuberculosis,"  are  also  useful  and  effective 
agencies  in  educating  the  people  upon  this 
subject.  By  concerted  action  on  the  part  of 
physicians,  sanitary  authorities  and  the  pul)lic, 
tuberculosis  may  be  stamped  out  and  become  in 
the  future  a  matter  of  interest  only  to  the 
historian  of  human  progress. — Maryland  Medi- 
cal Journal,  April  28,  1894. 

CASTRATION    IN    HYPERTROPHY    OF 
THE  PROSTATE  GLAND. 

When  Dr.  J.   William  White  first  suggested  to 
the  profession   the  operation  of  castration  for 
the  relief  of  hypertrophy  of  the  prostate  gland 
(Address  at  the   Annual  Meeting  of  the  Ameri- 
can Surgical  Association,  June  i,  1893,  Annals 
of   Surgery,     August,     1893),  on    theoretical 
grounds,  although  strongly  supported  by  experi- 
mental  evidence,   it  is   doubtful   whether  any- 
one appreciated  the  full  value  of  the  recom- 
mendation.    Cases    of   prostatic   hypertrophy 
are  of  extreme  frequency.     Sir  Henry  Thomp- 
son found  that  one  man  of  every  three  over  54 
years  of  age  eximined  after  death  showed  some 
enlargement  of  the  prostate  ;  one  in  every  seven 
had  some  degree  of  obstruction  present  ;  while 
one   in  fifteen    had   sufii:ient    enlargement  to 
demand  som.e  form  of  treatment.     In  this  coun- 
try to-day,  as  shown  by  the  last  census,  there 
are  more  than  three  millions  of  men  over  fifty- 
four  ;  of  these,  according  to   Thompson's  esti- 
mate, which  genito-urinary  specialists  consider  . 
a    conservative  one,  about  two  hundred  thou- 
sand  are    sufferers    from    hypertrophy  of  this 
gland,     'i'his  number  seems  very  large,  but  the 
assertions    of    Thompson    unquestionably   ex- 
press a  general  rule,  and  in  fact  every  surgeon 
must  have  seen  men  in  whoai   some   prostatic 
overgrowth  existed  before  the  fifty-fourth  year. 
The  lives  of  such  patients  are   threatened   be- 
cause, if  the  obstruction   is  not  removed,  the 
health  is  rapidly  undermined  by  the    retention 
of    urine    and    the    consequent    fermentative 
changes,  the  deleterious  influence  of  backward 
pressure  on  the  kidneys,  the  frequent  use  of  the 
catheter,  and  the  loss  of  sleep  incident  to  the 
incessant  demands  to  void  urine.     Heretofore 
the  surgeon  has  been  unable  to  afford  distinct 
relief  from  the  distressing  symptoms  of  an  ad- 
vanced case  of  this  affection.     If  the  patient's 
general  condition  would  warrant  the  very  consi- 
derable risk,    some  form  of  prostatectomy  was 
performed.      The     suprapubic     method     was 
recommended  for  a   time,   but  the   difiiculiies 
encountered  in  its  performance,  the  frequency 
of  suprapubic  fistula  as  a  sequel,  and  the  high 
mortality  following  the   operation  have  led  to 
its  almost  total  abandonment.     Perineal  pros- 
tatectomy is  also  attended   with  considerable 
risk,  on  account  of  the  free  hemorrhage,  which 
cannot  be  controlled  during  the  operation,  and 


114 


THE  CANADA  MEDICAL  RECORD. 


the  prolonged  anesthesia  which  is  necessary. 
In  addition  to  this,  the  operation  is  a  bungling 
one,  in  which  the  enlarged  gland  is  removed 
by  cutting,  scraping,  or  gouging,  while  the 
instrument  is  out  of  sight,  and  much  ot  the  time 
it  cannot  be  guided  even  by  the  finger.  Com- 
bined suprapubic  and  perineal  prostatectomy 
enables  the  operator  to  reach  and  enucleate 
the  gland  with  greater  freedom,  but  it  is  an 
operation  of  such  gravity  that  it  would  be 
contra-indicated  in  the  very  cases  in  which  the 
demand  for  relief  was  most  urgent. 

Perineal  prostatotomy  is  little  more  than  a 
palliative  measure,  which  does  some  good, 
temporarily,  by  draining  the  bladder  and  in- 
ducing slight  contraction  of  the  middle  lobe  of 
the  prostate  in  the  healing  process.  All  of  these 
operations  confine  the  patient  to  bed  for  seve- 
ral weeks,  which  is,  in  itself,  objectionable,  and 
in  addition  require  the  use  of  the  bougie  for  a 
long  time  afterwards. 

In  view  of  these  facts  it  is  not  strange  that 
surgeons  should  have  presented  Dr.  White's 
suggestion  to  patients  suffering  from  the  conse- 
quences of  prostatic  hypertrophy,  nor  is  it 
unnatural  that  such  patients  accepted  this 
chance  for  relief  from  a  condition  that  in  many 
cases  was  rapidly  and  surely  impairing  the 
health  of  a  person  otherwise  vigorous  and, 
apparently,  without  this  trouble  destined  to 
enjoy  many  additional  years  of  life. 

With  the  testes  already  or  soon  to  become 
functionless,  and  with  the  contemplation  of  a 
long  period  of  intense  suffering  which  will  be 
relieved  only  by  death,  sentimental  objections 
pale  into  insignificance,  and  the  problem  of 
securing  relief  without  placing  the  life  in  danger 
is  the  only  one  entitled  to  consideration; 

Cases  of  castration  based  upon  Professor 
White's  deductions  soon  began  to  be  reported. 
Ramm,  of  Christian ia,  Norway,  recorded  two 
in  September,  1893  ;  Haynes,  Los  Angeles,  Cal., 
and  White,  Philadelphia,  each  report  three 
cases  ;  Finney,  Baltimore,  reports  two  cases  ; 
Smith,  St.  Augustine,  Fla. ;  Powell,  London  ; 
Mayer  and  Haenel,  Dresden  ;  Moullin,  London ; 
Thomas, Pittsburg;  Ricketts,  Cincinnati;  Swain, 
Bristol,  England;  and  Bereskin,  Moscow,  each 
record  one  case.  Thus  far  eighteen  operations 
have  been  published.  All  have  been  more  or 
less  successful,  and  usually  the  relief  from  the 
distressing  symptoms  and  the  shrinking  of  the 
prostate  have  been  marvellous.  Tlie  least  favor- 
able cases  have  experienced  infinitely  greater 
relief  than  has  been  obtained  by  any  method 
heretofore  employed.  At  least  as  many  uni)ub- 
lished  cases  have  been  operated  upon  with 
equally  favorable  results.  There  have  been  no 
deaths  from  the  operation  :  of  course,  few  would 
be  expected  in  the  hands  of  com])etent  sur- 
geons. 

To  those  familiar  with  these  cases,  the  rapid 
shrinking  of  the  prostate  and  the  simultaneous 


relief  afforded  the  patient  have  been  tiuly  won- 
derful. The  operation  has  therefore  passed  the 
experimental  stage,  and  has  legitimately  estab- 
lished for  itself  a  position  among  the  most 
successful  of  operative  procedures.  Indeed, 
the  results  have  been  so  uniformly  favorable 
that  castration  may  now  be  considered  a  speci- 
fic for  hypertrophy  of  the  prostate. 

It  is  necessary,  however,  to  utter  a  word  of 
caution  here.  Castration  is  not  indicated  in 
every  case  of  prostatic  enlargement  or  urinary 
obstruction.  To  secure  uniformly  successful 
results,  one  must  be  certain  that  the  condition 
from  which  the  patient  is  suffering  is  appro- 
priate for  the  operation.  Cases  of  prostatic 
abscess,  prostatitis,  tumors  of  the  prostate  and 
of  the  region  of  the  neck  of  the  bladder,  and 
other  forms  of  obstruction  in  the  neighborhood 
of  the  prostate  must  be  distinguished  from  true 
prostatic  hypertrophy.  Without  careful  discrim- 
ination, both  the  surgeon  and  the  patient  w'ill 
be  disappointed,  and  the  operation  will  unne- 
cessarily be  brought  into  discredit. 

As  it  stands  to-day,  however,  in  appropriate 
cases,  it  appears  to  mark  an  advance  in  the 
surgery  of  the  prostate,  which,  when  the  gravity 
and  the  frequency  of  the  condition  of  hyper- 
trophy are  recalled,  together  with  the  more  or 
le>s  ineffectual  and  always  dangerous  methods 
of  treatment  which  have  prevailed,  must  be  a 
source  of  congratulation  not  only  to  Professor 
White  but  to  the  profession  at  large,  and  to 
thousands  of  patients  who,  having  outlived  their 
sexual  lives  and  earned  an  old  age  of  mental 
and  physical  repose  and  intellectua' enjoyment, 
have  had  only  a  few  short  years  of  torment  and 
misery  to  look  forward  to  on  account  of  this 
hitherto  intractable  disease. — Editorial  Uni- 
versity Medical  Magazine. 

CANCER    HOUSES    AND    THEIR 

VICTIMS. 
Dr.  d'Arcy  Power,  in  commenting  on  Mr. 
Shattock's  recent  statement,  that  cancer,  like 
tubercle,  may  repeatedly  show  itself  in  certain 
houses,  adds  a  series  of  cases  of  his  own  illus- 
trating this  point.  Miss  B.,  aged  45,  lived  in 
a  certain  house  in  the  suburbs  of  London  for 
thii-teen  years,  and  died  of  cancer  of  the 
stomach  in  1884.  Miss  T.,  aged  47  years,  who 
had  lived  in  the  house  for  twenty  years,  then 
occupied  her  bedroom,  and  died  of  cancer  of 
the  liver  in  1SS5.  Airs.  J.,  aged  67  years, 
who  had  lived  in  the  house  for  eight  years,  now 
occupied  the  bedroom,  and  died  of  cancer  of 
the  breast  and  uterus  in  1S93.  Each  of  these 
patients  appeared  to  be  in  perfect  health  until 
tliey  took  one  another's  place  as  housekeeper 
to  the  barmaids  of  the  establishment  in  which 
they  had  each  lived  for  so  long  a  time.  There 
'  was  no  blood  relationship  between  them.  One 
of  the  sons  of  the  house,  a  nephew  of  Miss  T., 
has  a  keloid  which  has  been  removed  three 
times. — British  Medical  Journal,  June  9,  1894. 


THE   CANADA   MEDICAL   RECORD. 


115 


THE  CANADA  MEDICAL  RECORD 

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ASSISTANT  EDITOR 
EOLLO  CAMPBELL,  C.M.,  M.D. 

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MONTEEAL,  FEBRUAEY,  1895. 


THE    ANTI-TOXIN     TREATMENT     OF 
DIPHTHERIA. 

From  reports  gradually  coming  in  from  relia- 
ble sources,  it  would  appear  that  the  anti-toxin 
treatment  of  diphtheria  is  more  than  a  passing 
fad.  Although  it  does  not  save  every  case,  there 
seems  to  be  no  doubt  that  it  reduces  the  mor- 
tality very  considerably.  The  most  satisfac- 
tory proofs  come  from  the  Children's  Hospital 
in  Paris,  where  the  treatment  is  being  tested  by 
Dr.  Roux  himself,  and  where,  in  order  that 
other  things  might  remain  equal,  exactly  the 
same  treatment  was  carried  out  by  the  regular 
physicians  of  the  institution.  The  result  was 
that  the  death  rate,  which  had  remained 
steadily  for  years  at  a  certain  figure,  has  come 
down  nearly  one-half.  There  are,  however, 
unfortunately  certain  sources  of  error  which  must 
be  eliminated  before  coming  to  a  conclusion. 
For  instance,  while  the  treatment  was  almost 
hopeless,  only  the  most  serious  cases,  such  as 
those  requiring  tracheotomy,  would  be  sent  to 
the  hospital ;  but  on  parents  learning  that  by 
sending  their  children  early  to  the  hospital  the 
new  treatment  was  almost  sure  to  save  them, 
many  cases  in  the  early  stage, and  probably  many 
cases  which  are  not'  diphtheria  at  all,  would  be 
received,  and  those  cases  would  have  recovered 
under  any  treatment,  so  that  the  normal 
b-ilance  would  be  disturbed,  and  the  anti-toxin 
treatment  would  receive  credit  to  which  it  was 
not  fairly  entitled.     Several  of  our  leading  prac- 


titioners, such  a^  Dr.  McConnell  and  Dr.  G.  T. 
Ross,  have  assured  us  that  they  were  satisfied 
that  the  remedy  is  a  valuable  one,  as  in  every 
case  the  most  marked  improvement  imme- 
dately  set  in,  the  membrane  coming  off  and  the 
breathing  becoming  easy.  We  think  the  same 
method  should  be  followed  here  as  we  have 
noticed  above  has  been  followed  in  Paris, 
namely,  to  continue  the  best  treatment  hitherto 
known  and  to  employ  the  anti-toxin  as  well. 
Everyone  admits  that  the  latter  can  do  no 
harm,  and  those  who  have  tried  it  believe  that 
it  does  good.  There  is  one  obstacle  to  its 
trial  being  carried  out  on  a  large  and  conclu- 
sive scale,  and  that  is  the  great  cost ;  but  this 
will  probably  soon  be  removed  by  the  estab- 
lishment in  Canada  of  a  serum  laboratory.  In 
the  meantime  we  should  petition  the  govern- 
ment to  issue  sharp  and  peremptory  orders  to 
the  customs  officials,  to  admit  it  free  of  duty 
until  such  time  that  it  can  be  produced  in  suffi- 
cient quantity  in  the  country.  We  cannot 
comprehend  the  calibre  of  the  official  mind 
which  taxes  anaesthetics,  vaccine  or  anti-toxin. 

SHOULD    PHTHISIS    BE     STAMPED 
OUT? 

Although  Koch's  tuberculin  has  not  apparently" 
fulfilled  the  high  hopes  held  out  by  its  inventor 
as  a  cure  for  the  dread  disease  in  man,  it  has 
during  the  past  year  come  to  be  recognized  as 
an  infallible  diagnostic  agent  of  tuberculosis  in 
cattle,  and  by  its  aid  thousands  of  tuberculous 
animals  have  been  discovered  and  slaughtered 
in  Canada  and  the  United  States.  The  pro- 
cess is  an- expensive  one,  but  Governments  and 
individuals  consider  that  it  will  pay  in  the  long 
run  to  incur  an  expense  of  several  million  dol- 
lars even^.  in  order  that  the  disease  may  be 
stamped  out  from  the  herds,  many  of  which  are 
of  the  highest  breed,  the  disease  being  more 
common  unfortunately  in  high  grade  animals 
than  in  the  commoner  ones. 

In  view  of  these  facts,  does  it  not  seem  strange 
that  so  little  has  been  done  towards  the  stamp- 
ing out  of  this  greatest  of  all  scourges  of  the 
human  race  ?  It  has  taken  many  hundreds  of 
years  to  find  out  that  it  was  not  an  inherited 
disease,  but  that  it  was  on  the  contrary  acquired 
by  contact  only.  But  now  that  no  educated 
person,  either  in  the  profession  or  even  among 


ii6 


THE   CANADA   MEDICAL   RECORD. 


the  laity,  has   the  slightest    doubt  of  its  con- 
tagiousness, does  it  not  seem  strange  that  some 
effort  is  not  made  to   restrict   the   number  of 
centres  of  contagion?     When  the    matter  was 
brought  up  recently  at    the  Montreal   Genera' 
Hospital  by  one  of  iItc  Governors,  asking  that  i 
arrangements  be  made   to  put  the  cases  of  con' 
sumption  in   wards    by    themselves,  instead    of 
sandwiching  them  between  other  patients,  whoi 
though  not  infected  with  the  dread  disease,  yet 
were,   owing  to   their  anaemic    condition,   in  a 
very  receptive  condition   for  the  attacks  of  the 
bacilli,  one  of  the  staff  who  opposed  isolation 
received  a  lesson  in  bacteriolgy  from  one  of  the 
laymen.     In  a  recent  article  entitled  "The  Con- 
sumption Scare,  "  the  writer  strongly  opposed 
isolation,  on  the  ground  of  the  hardships  which 
it  entails.     But   we  have  pointed  out  over  and 
over  again   in  the  columns  of  this  journal,  that 
isolation    of  the    majority    of  cases   could   be 
carried   out   with   very    little  hardship   by   the 
Dominion   Government  voting  a  sum  sufficient 
to   maintain  a   national    sanitarium,    in   which 
consumptives  born  or  resident  in  Canada  might 
receive  free  maintenance  and  treatment.     This 
would   doubtless  prove    so  attractive  that  the 
majority  of  patients  would  apply  for  admission 
of  their  own  accord.     Supposing  that  even  one 
thousand  people  availed  themselves  of  such  an 
establishment,  the   cost  would  not  exceed  two 
or  three  hundred  thousand  dollars  a  year.     Can 
anyone    deny    that   the  gathering    together   of 
that  many  people   under  the  best  sanitiry  and 
therapeutic   treatment,  who  are  now  acting  as 
so  many  widespread  centres  of  infection,  would 
be  a  judicious  expenditure  of  public  money? 
If  he  does  deny  it,  then  he  must  place  the  value 
of  human  life  and  happiness  far  below  that  of 
the  value  of  animals.     The  mere  fact  that  such 
,an  institution  existed  would  do  more  to  educate 
the  people  to  the  danger  of  consumptive  people 
spitting  in  street  cars  and  on  the  floors  of  their 
houses  than   any   amount   of  talking   to  them 
would  do.     In  the  meantime,  if  any  more  hospi- 
tals are  to  be   built  and  endowed,  wliy  siiould 
the  next  one  not  be  one  for  consumption  ?  It 
would  be  equal  to  extending  the  capacity  of  the 
existing  hospitals,    many    of   whose    beds    are 
occupied  by    consumptives  at  present,    to  the 
danger  of  the  other  i)atients.     We  are  glad  to 
learn  that  one  physician  at  least  in  this  city  is 
devoting  his  attention  specially  to  consumption 


with  good  success,  and  we  hope  ere  long  to  see 
in  the  leading  cities  of  Canada  hospitals  estab- 
lished where  not  only  the  poor  would  be  treated 
by  the  hospital  staff,  but  where  those  who  can 
pay  could  enter  for  treatment  under  the  care  of 
their  own  physician,  and  either  be  cured  or  die 
without  spreading  their  disease  to  other  mem- 
bers of  their  family. 

Why  do  we  isolate  the  insane,  for  which  we 
pay  willingly  nearly  a  million  dollars  a  year  ? 
For  the  public  good,  to  which  they  are  dan- 
gerous. And  yet  are  they  any  more  dangerous 
than  those  in  the  last  stage  of  consumption,  who 
are  daily  producing  one  of  the  roost  fatal  bac- 
teria known?  If  it  pays  us  to  spend  tens  of 
thousands  of  dollars  in  keeping  from  our  shores 
the  national  enemy  Cholera  by  our  quaran- 
tine stations,  and  to  spend  hundreds  of  thou- 
sands in  isolating  even  those  who  are  only  occa- 
sionally dangerous  to  society,  why  should  we 
not  spend  something  on  the  isolation  of  those 
who,  sound  in  mind,  recognize  the  danger  to 
which  they  are  exposing  their  families  and  wh  ) 
would  voluntarily  apply  for  admiss'on  ? 

THE  TYPHOID  OYSTER  SC.\RE. 

An  epidemic  of  typhoid  fever  having  broken 
out  in  a  Connecticut  college,  and  the  students 
having  a  few  days  previously  partaken  of  some 
oysters  which  had  been  transplanted  from  the 
sea  to  a  small  branch  of  the  Connecticut  river, 
and  remained  there  for  two  days  feeding  on 
sewage,  forthwith  the  luscious  bivalve  has 
had  its  reputation  destroyed  by  the  epidemic 
being  laid  entirely  at  its  doors.  A  great  deal 
more  is  blamed  on  oysters  than  they  are  justly 
answerable  for.  We  remember  an  old  gentle- 
man who  consulted  a  physician  for  a  headache, 
which  he  attributed  to  his  having  eaten  one 
oyster  the  night  before.  The  physician  thought 
the  explanation  insufficient,  when  on  further 
inquiry  it  appeared  that  the  old  gentleman  had 
washed  the  solitary  oyster  down  with  a  whole 
bottle  of  old  port.  So  in  the  case  of  the  Con- 
necticut college  attacked  by  typhoid,  while 
admitting  the  possibility  of  oysters  becoming 
infected  by  feeding  on  sewage  containing 
typhoid  bacilli,  yet  we  think  there  were  far  more 
Jikely  sources  for  it  to  come  from.  For 
instance,  there  were  two  cases  of  typhoid  at  a 
farm  house  a  little  way  up  the   river  ;  did  the 


THE  CANADA  MEDICAL  RECORD. 


117 


farmer  or  some   other  with  a  typhoid  infected 
well  supply  milk  to  the  college  ? 

During  the  cour.se  of  a  collective  investiga- 
tion held  some  years  ago  in  Montreal,  nearly 
all  the  cases  in  the  city  were  traced  to  two 
milkmen  who  had  typhoid  infected  wells,  and  as 
a  result  of  the  investigation  one  of  them  gave 
up  his  business.  If,  however,  these  oysters 
actually  contained  typhoid  bacilli  in  iheir  livers 
at  the  time  they  were  eaten,  would  not  the  dis- 
ease be  much  milder  in  those  who  ate  them 
than  if  they  had  swallowed  the  bacilli  in  all 
their  savage  ferocity  ?  It  has  been  proved 
beyond  a  doubt  that  nearly  all  bacilli  may  be 
domesticated,  so  to  speak,  by  being  cultivated 
for  a  few  generations  in  some  animal's  blood 
May  it  not  be  that  even  such  a  humble  anima- 
as  the  oyster  may  serve  a  good  turn  in  immun 
izing  man  against  the  attacks  of  wild  typhoid 
bacilli?  So  that  having  had  a  few  milder  and 
milder  attacks  of  typhoid  from  oysters,  college 
students  would  become  proof  against  all  dan- 
ger of  being  attacked  by  a  fatal  form  of  bacil- 
lus from  milk  diluted  with  water  from  a 
typhoid  infected  well.  The  oyster  scare  has  been 
a  serious  matter  for  the  thousands  of  poor 
oyster  fishermen  on  the  Atlantic  coast,  the 
sales  having  fallen  off  during  the  last  few 
weeks  as  much  as  four  thousand  dollars  a 
week.  While  admitting  the  possibility  of  oys- 
ters becoming  infected  by  their  food,  we  main- 
tain that  they  are  no  more  deserving  of 
suspicion  than  the  fish  which  live  on  sewage 
almost  exclusively,  but  which,  though  eaten 
in  far  greater  quantities,  have  so  far  never  been 
accused  of  conveying  typhoid  to  their  patrons. 
We  would  respectfully  suggest  that  a  sharper 
lookout  be  kept  upon  the  milk  and  water 
man,  where  ample  cause  for  typhoid  will  in 
most  cases  be  found. 


THE  PRACTITIONER  OF  ST.   LOUIS. 

The  vvelcome  which  we  always  extend  to  new- 
comers to  the  ranks  of  medical  journalism  is 
all  the  more  hearty  in  the  case  of  the  one 
whose  title  appears  above,  because  the  editor  is 
one  of  our  old  students  at  Bishops  College, 
Dr.  R.  C.  Blackmer,  who  is  now  professor  of 
Medical  Jurispruduice  in  the  Barnes  Medical 
College  of  St.  Louis.     In  his  opening  editorial 


the  editor  repudiates  the  idea  that  his  journal 
comes  to  fill  a  long  felt  want,  or  that  :inybody 
wants  it.  But  he  has  something  to  say,  and 
he  says  it  remarkably  well,  and  he  is  going  to 
let  the  profession  hear  from  him  and  his  asso- 
ciate editors  once  a  month.  As  a  student  Dr. 
Blackmer  was  a  favorite  with  his  fellow-stu- 
dents as  well  as  with  his  professors,  due  to  his 
geniality  of  disposition  and  originality  of 
thought, — qualities  which  should  serve  him  in 
good  stead  in  his  capacity  of  a  medical  editor. 
We  trust  that  the  SL  Lou/s  Pradifioucr  will  do 
its  utmost  to  raise  the  standard  of  medical 
education  in  its  own  State  by  the  formation  of 
a  State  examining  board,  if  there  is  not  already 
one,  and  the  compulsory  registration  of  all 
diplomas  from  recognized  medical  colleges 
before  their  holders  shall  be  allowed  to  practise. 
We  wish  Dr.  Blackmer  every  success. 


THE  CANADIAN  MEDICAL  REVIEW. 

We  are  pleased  to  welcome  to  our  exchange 
list  this  the  latestadditioa  to  the  ranks  of  Cana- 
dian medical  journals.  Being  edited  by  such 
men  as  Dr.  W.  H.  B.  Aikins,  A.  B.  Atherton, 
J.  H.  Burns,  G,  Sterling  Ryerson,  J.  Ferguson, 
Albert  A.  McDonald  and  Allen  Barnes,  we  are 
not  surprised  to  find  that  it  is  a  bright  and 
interesting  periodical.  Although  there  is 
always  room  for  one  more,  we  must  admit  that 
with  eight  medical  monthly  publications,  the 
five  thousand  doctors  of  Canada  are  well 
supplied  with  reading,  and,  all  things  consider" 
ed,  they  receive  good  value  for  their  subscrip- 
tions. With  a  little  more  patriotism  and  a 
little  more  energy  on  the  part  of  the  profession, 
the  medical  journals  of  Canada  might  be  greatly 
improved.  For  many  physicians  of  Canada 
subscribe  for  foreign  journals  without  taking 
even  one  of  our  own,  and  the  majority  never 
write  as  much  as  a  letter  to  the  home  journals, 
nor  contribute  an  idea,  while  the  few  who  do 
write  too  often  send  their  articles  for  publication 
to  a  foreign  publication.  Most  medical  men 
must  have  at  least  one  original  idea  a  year, 
which  might  be  useful  to  the  profession  ;  why 
will  they  not  jot  it  down  and  send  it  in  ? 


ii8 


THE   CANADA   MEDICAL    RECORD. 


CANADIAN    MEDICAL    ASSOCIATION. 

Those  who  attended  the  last  meeting  of  the 
above  Association  at  St.  John,  N.B.,  were  all 
agreed  that  it  was  one  of  the  most  successful 
in  the  annals  of  the  Association,  From  recent 
information  received  from^Kingston  it  would 
appear,  however,  that  the  meeting  next  year 
promises  to  be  a  still  more  successful  one. 
The  secretary  has  received  letters  from  all 
parts  of  the  Dominion,  stating  that  the  writers 
would  be  present  at  the  Kingston  meeting, 
which  will  be  held  on  the  28th,  29th  and  30th 
of  August. 

The  American  Electro  Therapeutic  Associa- 
tion, which  comprises  the  leading  authorities 
on  the  subject  from  all  over  America,  both  in 
Canada  and  the  United  States,  will  hold  its 
annual  meeting  at  Toronto,  beginning  the  day 
following  the  end  of  the  Kingston  meeting,  so 
that  the  members  of  the  Canadian  Medical  can 
proceed  next  day  to  Toronto  and  be  present 
at  the  Electro  Therapeutic  meeting,  where  all 
are  welcome  without  being  Fellows.  We  would 
suggest  that  as  many  as  possible  would  avail 
themselves  of  the  double  opportunity.  Few 
outside  of  the  Association  are  aware  of  the 
advances  which  electricty  has  been  making 
during  the  last  few  years  as  a  therapeutic  agent, 
and  much  valuable  information  might  doubt, 
less  be  acquired  at  small  cost  by  attending  the 
meeting  in  which  men  like  Rockwell,  Morton 
Goelet,  Massey,  Newman,  Dickson,  and  other 
well-known  writers  will  take  an  active  part. 
Every  Canadian  practitioner  of  medicine 
should  make  the  attendance  at  the  meeting 
of  the  National  Medical  Association  of  Canada 
at  Kingston  the  one  great  event  of  the  year. 

ACKNOWLEDGMENT. 

We  have  much  pleasure  in  giving  credit  to 
Dr.  J.  B.  McConnell  of  Montreal,  for  an 
abstract  of  his  excellent  article  on  the  treat- 
ment of  inebriety  by  nitrate  of  strychnine.  The 
journal  from  which  we  copied  it  had  omitted 
to  say  that  it  was  an  abstract  of  Dr.  McConnell's 
paper,  and  our  printer,  not  seeing  any  name 
mentioned,  failed  to  credit  it  to  anyone.  \Ve 
hope  Dr.  McConnell  will  consider  it  the 
greatest  compliment  we  could  pay  him  that  we 
printed  his  article  on  its  own  merits  without 
even  knowing  that  it  was  h4S. 


BOOK  NOTICES. 

On  Preservation  of  Health  in  India.      By 

Sir  James  Fayre,    K.C.T.S.,  M.D.,  F.R.S., 

President  of  Medical  Board  India  Office. 

London  :  Macmillan  &  Co.,  and  New  York, 

1894.     Copp,  Clark  Co.,  Ltd.,  pubHshers, 

9  Front  Street  W.,  Toronto. 

The  lecture  by  such  a  distinguished  author 

should  be  read  by  all  who  intend  to  live  in  the 

tropical  climate.     Tiiey   would   learn   how  life 

there  may  be  rendered  as  safe  as  anywhere  else. 

Surgical  Pathology  AND  Therapeutics.    By 
John   Collins  Warren,  M.D.,  Professor  of 
Surgery  in   Harvard  University  ;  Surgeon 
to    the    Massachusetts  General   Hospital. 
832  pages,  illustrated  by  120  engravings 
and  4  colored  plates.    Philadelphia  :  W.  B. 
Saundeis,  925  Walnut  street,  1895. 
As  the  author  truly  says  in  his  preface,  the 
scientific  portion  of  a  surgical  education  was 
formerly    regarded    as   something   apart    and 
ornamental,    but  it  has   now   become  an  emi- 
nently practical  feature  of  the  student's  curricu- 
lum.    No  young  practitioner  can  be  regarded 
as  thoroughly  equipped   for  siirgical  work  who 
is  not  both   a  good  pathologist  and  an  expert 
bacteriologist.     1  he  confideiice  born  of  a  know- 
ledge of  pathology  and  bacteriology  enables  him 
to  assume  grave  responsibilities'  and  to  grapple 
successfully  wiih  the  most  complicated  prob- 
lems.    It  is   from  men  thus  equipped  that  we 
have  a  right  to  hope  that  the  future  Masters 
of  Surgery  are  to  be   evolved.     An  attempt  is 
therefore  made  in  this  book  to  associate  path- 
ological conditions  as  closely  as  possible  with 
the  sym])loms    and  treatment  of  surgical  dis- 
eases, and  to    impress   upon  the    student    the 
value  of  those  lines  of  Scudy  as  a  firm  founda- 
tion for  good  clinical  wck. 

It  is  the  author's  hope  that  the  following 
pages  will  present  to  a  large  number  of  prac- 
tising physicians,  in  a  readable  form,  many 
subjects  that  received  but  little  attention  when 
they  graduated. 

The  illustrations  by  William  J.  Kaula  are, 
with  one  or  two  exceptions,  original.  The  draw- 
ings of  microscopical  sections  are  taken  from 
specimens  prepared  for  the  purpose,  and  are 
intended  to  illustrate  as  closely  as  i)ossible  the 
results  of  modern  microscopical  technique. 

We  have  carefully  read  over  several  chapters, 
and  can  say  witliout  hesitation  that  tiiis  work 
is  thoroughly  up  to  date  and  written  in  a 
l)leasant  and  instructive  style.  The  chapters  on 
tuberculosis  of  the  joints  and  on  tumors  are  es- 
l)ecialiy  well  wriiten.  We  heartily  commend 
this  book  to  our  most  thoughtful  readers.  It 
mUy  be  obtained  through  any  bookseller. 

Transactions  oi' the  College  of  Physicians 
OF  Philadelphia. — Third  series,  volume 


THE  CANADA  MEDICAL  RECORD. 


119 


sixteen.      Philadelphia :    printed    for    the 

College,  1894. 
We  welcome  these  transactions  more  than 
ever;  the  present  volume  contains  many  gems 
from  the  pens  of  the  talented  members  of  this 
Society.  There  are  few  societies  in  the  world 
which  can  turn  out  such  a  volume  as  this  at 
the  end  of  every  year. 

A   Practical   Theory   and   Treatment    of 

Pulmonary   Tuberculosis,  by  Frank  S. 

Parsons,   M.D.,  editor  of  the  Philadelphia 

Medical   Times  and  Register.     Published 

by  the  Medical  Publishing  Compan) ,  718 

Betz  Building,  Philadelphia,  Pa.    Price,  25 

cents.     Paper  cover. 

This  monograph  covers  seventy-seven  pages 

of  a  neat  little  volume.     It  treats  of  a  subject 

of  universal  interest  to  all  scientifically  inclined 

persons. 

The  author  views  tuberculosis  in  a  new  light, 
and  from  a  more  rational  standpoint  than  any 
that  has  recently  been  advanced.  This  work, 
it  is  safe  to  say,  marks  a  new  era  in  the  study 
of  this  disease. 

The  first  pages  are  devoted  to  an  interesting 
introductory,  illustrative  of  the  present  condi- 
tion of  medical  thought  upon  the  subject.  The 
causation  of  tuberculosis  is  then  taken  up,  and 
it  is  admirably  and  ably  shown  that  the  domi- 
nant theory  regarding  the  tubercle  bacillus  as  a 
causative  agent  is  not  based  on  the  true  patho- 
logical condition  in  the  early  stage  of  phthisis. 
Bacilli  are  to  be  regarded  only  as  developments, 
existing  because  a  favorable  medium  presents. 
This  medium  exists  before  the  bacillus  is 
demonstrable,  and  consists  of  the  waste  ele- 
ti  ents  of  the  blood  congregating  in  a  locality 
through  lymphatic  obstructions  or  stasis. 

In  the  pages  devoted  to  a  consideration  of 
symptomatology  it  is  suggested  that,  in  view  of 
the  universal  dislike  of  fats  by  phthisical  per- 
sons, there  doubtless  exists  a  disordered  condi- 
tion of  the  pancreas,  which  condition  may  be 
congenital  or  acquired. 

Dr.  Parsons  has  based  the  treatment  of  con- 
sumption on  the  lines  of  this  new  theory,  call- 
ing attention  to  the  advantages  to  be  gained  by 
elimination,  nutrition  and  oxygenation.  The 
low  price  of  the  book  places  it  in  reach  of 
everyone,  and  no  physician  should  be  without 
it. 


PAMPHLETS. 

Inflammation  of  the  Ureters  in  the 
Female,  by  Matthew  D.  Mann,  A.M., 
M.D.,  of  Buffalo,  from  the  American 
Journal  of  the  Medical  Sciences,  August, 
1894. 

The  Technique  of  Vaginal  Hysterectomy, 
by   George   M.    Edebohls,    A.M.,    M.D., 


Gynaecologist  to  St.  Francis'  Hospital,  New 
York  ;  Professor  of  Diseases  of  Women 
at  the  New  York  Post-Graduate  Medical 
School  ;  Consulting  Gynaecologist  to  St. 
John's  Riverside  Hospital,  Yonkers,  New 
York.  From  the  American  Journal  of  the 
Medical  Sciences,  January,  i8;>5. 

Notes  on  Movable  Kidney  and  Nephror- 
rhaphy,  by  George  M.  Edebohls,  A.M., 
M  D.,  Gynecologist  to  St.  Francis  Hospi- 
tal, New  York,  etc. 

A  New  Method  for  Anchoring  the  Kidney. 
Read  before  the  Columbus  (Ohio)  Aca- 
demy of  Medicine,  Nov.  19,  1894.  By  R. 
Harvey  Reed,  M.I^.,  Professor  of  Theory 
and  Practice  of  Surgery  and  Clinical  Sur- 
gery Ohio  Medical  University ;  Surgeon 
Protestant  Hospital,  etc.  Reprinted  from 
the  Journal  of  the  American  Medical  Asso- 
ciation, December  22,  1894.  Chicago  : 
American  Medical  Association  Press,  1894. 

The  Use  of  the  Galvanic  Current  in  Arti- 
cular Inflammatory  Exudations.  By 
M.  A.  Cleaves,  M.D.  Reprinted  from  the 
Times  and  Register,  December  19,  1891. 
Philadelphia  :  The  American  Medical 
Press  Company,  Limited,  1891. 

Electric  Light  as  a  Diagnostic  Therapeu- 
tic Agent.  By  Margaret  A.  Cleaves,  M.D., 
Instructor  in  Electro-Therapeutics,  New 
York  Post- Graduate  Medical  School.  Re- 
printed from  the  Medical  Record,  Decem- 
ber 8,  1894.  New  York  :  Trow  Directory, 
Printing  &  Bookbinding  Co.,  201-213 
East  Twelfth  Street,  1894. 

The  Diagnosis  and  Treatment  of  "  Float- 
ing Kidney."  By  R.  Harvey  Reed, 
M.D.  (Univ.  of  Penna.),  Columbus,  Ohio. 
Professor  of  Theory  and  Practice  of  Sur- 
gery and  Clinical  Surgery  Ohio  Medical 
University  ;  Consulting  Surgeon  B.  &  O. 
and  Big  Four  Railways ;  Surgeon  Protes- 
tant Hospital,  etc.  A  paper  read  by  spe- 
cial invitation  before  the  Sixth  Annual 
Meeting  of  the  Shelby  County  Medical 
Society,  at  Shelbyville,  Ind.  Reprinted 
from  Columbus  Medical  Journal,  April, 
1894. 

Une  Mission  en  Belgique  et  en  Hollande  : 
l'Hygiene  et  l'Assistance  Publiques  ; 
l'Organisation  et  l'Hygiene  Scolaires. 
Par  le  Dr.  C.  Delvaille,  avec  une  preface 
de  M.  Grancher,  Piofesseura  la  Faculte  de 
Medecine  de  Paris.  Paris:  Societe  d' Edi- 
tions Scientifiques,  Place  de  I'Ecole  de 
Medecine,  4,  Rue  Antoine-Dubois,  1895. 

Lois  de  la  Creation  des  Sexes;  des  moyens 
de  s'assurer  une  Progeniture  Male. 
Par  le  Dr.  A.  Cleisz.  Paris:  Societe 
d'Editions  Scientifiques,  4,  Rue  Antoine- 
Dubois,  1895.     Tons  droits  reserves. 


120 


THE   CANADA   MEDICAL   RECORD. 


Three  Cases  of  'Uterus  Bicornis  Septus  ; 
WITH  Report  of  Operations  performed 
UPON  THEM.  By  George  M.  Edebohls, 
A.M.,  M.D.,  Professor  of  Diseases  of  Wo- 
men at  the  New  York  Post  Graduate 
Medical  School  and  Hospital ;  Gynrecolo- 
gist  to  St.  Francis'  Hospital,  New  York. 
Reprinted  partly  from  the  New  York  Jour- 
nal of  Gynaecology  and  Obstetrics,  April, 
1893  ;  and  partly  from  the  Transactions  of 
the  New  York  Obstetrical  Society,  Jan. 
16,  1894. 

Polyclinique  de  l'Hopital  Internationale  : 
DES  Applications  de  la  Micrographie 

ET  DE  la  BaCTERIOLOGIE  A  LA  PRECISION 

DU  Diagnostic  Chirurgical.  Par  le 
Docteur  Aubeau.  Avec  24  figures  hors 
texle  en  photogravure.  Paris  :  Societe 
d'Editions  Scieniifiques,  Place  de  I'Ecole  de 
Medecine,  4,  Rue  Antoine-Dubois,   1894. 

LeS    NoUVELLES    MeTHODES  DANS  LE    TrAITE- 

MENT  DE  LA  DiPHTHERiE.  Par  le  Dr.  de 
Cresantignes,  Membre  de  la  Societe  de 
Medecine  et  de  Chirurgie  Pratiques,  Mede- 
cin  du  Ministere  de  I'Agriculture,  Officier 
d'Acadeinie,  etc.,  etc.  Prix  2  francs.  Paris  : 
Societe  d'Editions  Scientifiques,  Place  de 
I'Ecole  de  Medecine,  4,  Rue  Antoine- 
Dubois,  1895.     Tous  droits  reserves. 


PUBLISHERS  DEPARTMENT. 

LITERARY  NOTES 
From  The  Ladies'  Home  yournal,  Philadelphia. 

— Dr.  Parkhurst's  first  article  to  women  in  71f 
Ladies  fJome  Jvtirnal  has  proved  so  popular  that  the 
entire  huge  edition  of  the  February  issue  of  the  magazine 
was  exhausted  within  ten  days,  and  a  second  edition  of 
45,000  copies  has  been  printed. 

— Lady  Aberdeen  tried  a  novel  solution  of  the  evei* 
vexing  servant-girl  problem  in  her  homes  in  .Scotland 
and  Canada,  and  in  the  April  number  of  The  Ladies'' 
Home  Journal  she  will,  in  an  article,  explain  the 
method  she  adopted. 

— No  Antikamnia  "  Habit."  Some  physicians  may 
fear  to  prescribe  Antikamnia  in  chronic  cases  for  fear  of 
some  danger  arising  from  its  continued  use.  But  in  a 
letter  bearing  date  Nov.  8,  1894,  written  to  a  friend, 
Dr.  Hunter  McGuire  of  Richmond,  Va.,  says  :  "  I  do  not 
see  any  reason  why  you  should  not  continue  to  take 
Antikamnia  which  you  say  lias  done  you  so  much  good. 
\Ao  not  believe  it  will  do  you  any  harm." 

— To  be  a  constant  reader  of  LittcWs  Living  Age  is 
to  keep  a  mind  well  stored  with  the  best  foreign  liter- 
ature of  the  day.  To  have  read  it  all  one's  life,  if  one 
has  reached  maturity,  is  to  have  a  knowledge  of  philo- 
sophy, art,  science  and  literature,  which  is  of  itself  a 
liberal  education.  These  numbers  comprise  what  is 
most  notable  in  the  great  reviews  and  monthlies,  such  as 
Sidney  Whitman's  article  on  "Count  Mollke,  Field 
Marshall,"  Mrs.  Alexander's  "  Recollections  of  James 
Anthony  Proude,"  E.  N.  Buxton's  interesting  paper  on 
"  Stony  Sinai,"  Prince  Kropotkin's  "Recent  Science," 
etc.,  etc.  The  first  numl^er  in  February  shows  a  delight- 
ful table  of  contents  :  "A  Little  Girl's  Recollections  o 
Elizaljeth  Barrett  Browning,  William  Makepeace' 
Thackeray,  and  the  Late  Emperor  Louis  Napoleon,''  by 
Henriette  Corkran ;   "The    Q"^<^"   ^^^   Lord   15eacons- 


field,"  by  Reginald  B.  Brett  ;  "  Treasure  Islands  in  the 
Polar  Sea,"  with  Part  III.  of  "  The  Crimea  in  1854 
and  1894,"  by  General  Sir  Evelyn  Wood,  G.C.B., 
V.C.,  etc.  The  same  issue  contains  also  the  first  instal- 
ment of  "  The  Closed  Cabinet,"  a  powerful  short  story 
which  is  concluded  in  the  following  number. 

Any  reader  desiring  to  be  in  touch  with  foreign 
periodical  literature  cannot  do  better  than  subscribe  for 
this  invaluable  magazine.  A  prospectus  with  special 
offers  to  new  subscribers  may  be  obtained  by  addressing 
LiTTELL  &  Co.,  Boston. 

— The  March  number  of  the  Political  Science  Quarterly 
opens  witii  an  exposition  of  the  legal  question  involved 
in  the  matter  of"  Municipal  Home  Rule,"  by  Prof.  F. 
J.  Goodnovv  ;  Mr.  Edward  Porritt  presents  another 
phase  of  the  municipal  question  in  explaining  "  The 
Housing  of  Workingmen  in  London  "  ;  Prof  Simon  N. 
Patten  offers  "  A  New  Statement  of  the  Law  of  Popu- 
lation"; Mr.  H.  C.  Emery,  of  Bowdoin  College,  dis-" 
cusses  at  length  "  Legislation  Against  Futures"  ;  Prof. 
W.  J.  Meyers  investigates  the  cost  of"  Municipal  Elec- 
tric Lighting  in  Chicago  "  ;  Prof.  J.  B.  Moore  presents 
the  first  instalment  of  a  sketch  of  "  Kossuth  the  Rtvo- 
lutionist  " ;  and  Dr.  Frank  Zinkeisen,  of  Cambridge, 
criticizes  the  views  of  Siubbs  and  other  historians  on 
"  Anglo-Saxon  Courts  of  Law"  The  number  contains, 
moreover,  the  usual  Reviews  and  Book  Notes. — GiNN 
6^  Company,  Publishers,  Boston. 

MALIGN    TUMORS    OF   THE    KIDNEY^ 
Thorkild  Rovsing,    of  Copenhagen,    makes 
a  contribution  toward  the  diagnosis  and  treat- 
ment of  malign  tumors  of  the  kidney,    based 
upon  7  cases   observed    by   him,    of  which  5 
were  operated    upon.     Of  these    5,  in  all    of 
which     nephrecton)y     was    performed,    death 
occurred  in  3  shortly  after  the  operation,  while 
2  recovered.     In  i  of  these  2  latter  cases  death 
occurred  three  years  after  the  operation,  from 
local  recurrence,   the   pririiary  growth  being  a 
round-celled  sarcoma.     The   other   patient,   a 
man   aged   59,    with  a  spindle-celled    sarcoma, 
was   free   from   recurrence  when  observed  one 
year  after  the  operation.     In  both  these  cases 
no  tumor  of  the  kidney  was  to  be  discovered 
by  means  of  palpation,  while  in  tlie  remaining 
cases  a  large  tumor  could  be  felt.     The  author, 
therefore,   thinks    that    tumors  of  the    kidney, 
wliich   have   reached  such   a  size  as  to  be  dis- 
tinctly palpable,  are  generally  not  worth  operat- 
ing upon,  the  operation  itself  being  dangerous 
and   the  radical  removal  exceedingly  difficult. 
The  .early  diagnosis  is,  tiicuj  of  utmost  impor- 
tance, and  should  be  based  upon  (i)  a  careful 
examination  of  the   history  of  the  case  ;  (2)  a 
thorough    microscopical     examination    of  the 
urine    (in   3  cases   observed    by    Rovsing  the 
microscopical      examination      of    the      urine 
revealed    the    presence    of    elements    of   the 
growths) ;   (3)  palpation    during   narcosis  (the 
least    reliable    of  all  means   of  examination)  ; 
and  (4)  direct  exploration  by  means  of  lumbar 
incision.     Finally,  the  author  calls  attention  to 
the  f  ct  that  malign  tumors  of  the  kidney  most 
frequently  have  their  prim.iryseat  in  the  upper 
part  of  the  kidney. — Hospitals- Tiikndc^  Nos. 
20-22,  1894. 


€aiila   Mtlfeil  Btctil 


4> 


Vol.  XXriI. 


MONTREiVL,  MA.RCH,  1895. 


No.  6. 


ORIGINAL  COMMUNICATIONS. 

Kcport  on  Coroners'  Inquest 121 

SOCIETY  PROCEEDINGS. 

Montreal   Medico-Cliirurgical   Soci- 
ety   127 

Two  Cases  of  Skin  (irafting 127 

Aortic  Stenosis  and  Incompetence 

witli  Tricuspid  Involvement 127 

Notes  on  a  Celebral  Tumor  128 

End  to   End  Anastomosis  of  Intes- 
tines  by  means   of    the   Murpliy 

Button  128 

American  Academy  of  Medicine,...  131 
Eighth  Frencli  Congress  of  Surgery.  132 

Contagion  of  Cancer 132 

Midland  INIedical  Society 132 

Modern   Treatment   of   Pulmonary 

Phthisis  132 

Eighth    International    Congress    of 

Demography  and  Hygiene 134 

I>iphtheria 134 


PROGRESS  OF  SCIENCE. 

Treatment  of  Severe  Allniminuria 
Associated  with  Pregnancy 13G 

The  Antitoxin  Treatment  of  Diph- 
theria   136 

Foreign  Body  in  the  Gullet;  Subhyoid 
Pharyngotomy  ;  Recovery 138 

Castration  for  Hypertrophy  of   the 
Prostate ^. 138 

Electrolytic  Treatment  of  Tumors..  138 

Acetanilide  for  Vomiting ; 138 

The  Value   of  Chloroform  in  Inter- 
nal Medicine  139 

Fistula  in  Ano 139 

On  the  Use  of   Antipyrin  in  large 
Doses 140 

Potassium  Nitrate  in  the  Treatment 
of  Phlegmasia  Alba  Dolens 140 

Physiological  Rest  in  the  Treatment 
of  Prolapse  of  the  Rectum 141 

Diagnosis  of  Appendicitis    by    Pal- 
pation   141 

The  Danger  of  Anesthetizing  Diabe- 
tics   141 


EDITORIAL. 


The  Samaritan  Hospital  for  Women, 

Montreal     142 

Overcrowded  Professions 142 

Medical  Items 143 


BOOK  NOTICES. 

Diseases  of  the  Ear 143 

Publishers  Department 141 


jrigfnal    tfommunicatrons. 


REPORT  ON  CORONERS'  IN- 
QUESTS. 

The   Honorable  the  Attorney  Gen- 
eral, 

Quebec. 

Sir, — For  the  sake  of  convenience,  I 
have  placed  in  an  appendix  the  informa- 
tion obtained  during  my  recent  trip  to 
Coroner's  Courts  in  the  United  States ; 
and  have  also  added  some  other  statistics, 
etc.,  bearing  upon  the  subject  of  reforming 
the  Coroner  law,  with  comments. 

In  the  past,  the  chief  complaints  in  re- 
gard to  the  Coroner's  Courts  of  this  Pro- 
vince seem  to  have  been  that  (i)  deaths 
were  investigated  which  were  not,  in  the 
first  instance,  strongly  suspicious  ;  (2)  that 
the  investigations  were  unsatisfactory  and 
inconclusive;  and  (^3)  that  the  expense 
appeared  excessive  in  proportion  to  the 
results  obtained. 


The  various  changes  in  the  Coroner  law 
of  the  Province  do  not  appear  to  have  re- 
moved these  objections,  and  the  new  ar- 
rangement made  in  Montreal,  at  the  com-, 
mencement  of  the  present  year,  of  having  a 
lawyer  appointed  as  Coroner,  with  an 
official  physician  to  make  all  medical  ex- 
aminations, has  not,  as  yet,  greatly  im- 
proved matters. 

In  this  connection,  it  must  be  remem- 
bered that  the  plan  of  an  official  medical 
examiner  has  not  had  a  fair  trial  during 
the  nine  months  for  which  it  has  been  in 
force,  as  the  medical  expert  has  only  been 
consulted  in  less  than  one-half  of  the  in- 
quests ;  and  in  eighty-five  of  the  eighty- 
eight  preliminary  enquiries,  made  from 
January  to  May,  1893,  was  not  consulted 
at  all  ;  owing,  no  doubt,  to  the  absence  of 
definite  instructions  from  head-quarters 
upon  this  point.  It  is  evident  that,  where 
the  official  physician  is  not  summoned,  the 
Coroner  becomes  responsible  for  the  in- 
vestigation of  both  medical  and  legal  sides 
of  the  case. 


122 


THE   CANADA   MEDICAL   RECORD. 


NUMBER  OF  INQUESTS  HELD. 
The  number  of  deaths  investigated  in 
the  Montreal  district  by  the  Coroner  has 
been  at  the  rate  of  1.3  per  annum  per  1,000 
population,  and  the  number  of  inquests  at 
the  rate  of  i.o.  These  numbers,  judging 
by  the  experience  of  cities  elsewhere,  do 
not  appear  to  be  excessive,  the  number  in 
all  parts  of  the  \\  orld  ranging  between  1 
and  3  per  1,000.  New  York  investigates 
3.0;  Philadelphia  2.7;  London  2.0; 
Pittsburg  2.0;  Buffalo  2.0;  Baltimore  2.4; 
Washington  2.5  ;  Birmingham  2.4;  Liver- 
pool 3.0;  Charlestown  4.0;  Newark  2.3; 
Chicago  1.5  ;  Cleveland  1.3  ;  Wilmington 
1.3;  St.  Louis  2.4;  Boston  1.2;  New 
Haven  i.i  ;  and  Milwaukee  1.5  ;  while,  of 
a  number  of  the  other  cities,  of  which  I 
have  reliable  returns,  there  is  not  one 
where  less  than  one  death  is  invesligated 
yearly  for  every  thousand  inhabitants. 

While  this,  no  doubt,  shows  that  about 
this  proportion  of  deaths  may  be  expected 
to  occur  annually  in  a  large  city,  under  cir- 
cumstances calling  for  an  investigation  of 
some  sort,  it  does  not  necessarily  follow 
that  inquests  should  be  held  and  a  jury 
summoned  in  all  these  cases.  It  seems 
customary,  in  most  places,  to  make  a  pre- 
liminary enquiry,  in  order  to  see  whether 
the  death  is  really  -due  to  violence.  Ac- 
cording to  the  thoroughness  with  which 
this  enquiry  is  made,  the  number  of  deaths 
calling  for  an  inquest  is  reduced  to  three- 
fourths,  one-half,  or  even  one-fourth  of  the 
total  number  reported   for  investigation. 

The  Quebec  statute  of  1892  necessitates 
a  preliminary  enquiry  by  the  Coroner  be- 
fore deciding  to  hold  an  inquest  ;  and,  if 
a  careful  and  satisfactory  enquiry  could  be 
enforced,  there  would  be  no  grounds  for 
holding  inquests  in  more  than  one-fourth 
of  the  total  number  of  deaths  reported  as 
suspicious  in  Montreal  ;  in  other  words, 
less  than  100  inquests  would  be  iield  in 
each  year.  The  Quebec  statute  differs 
materially    from    that  of  ICngland,  which 


compels  Coroners  to  hold  public  inquests 
in  all  cases  of  deaths  not  due  to  natural 
causes,  and  in  all  deaths  in  prison  from 
any  cause  whatever.  In  Ontario,  where 
the  statute  is  the  same  as  Quebec,  no  in- 
quests are  held  in  cases  of  accident  from 
negligence  of  the  deceased  or  cases  of  sui- 
cide. 

It  seems  better  in  the  interest  of  society 
that  inquests  should  be  held  in  cases  of 
suicide,  in  order  to  check  its  frequency  ; 
as,  in  comtrics  where  this  is  not  done,  sui- 
cide is  decidedly  more  frequent ;  but  the 
present  Quebec  statute  leaves  it  doubtful 
whether  inquests  must  be  held  on  suicides 
or  not. 

The  idea  of  the  Quebec  statute  of  1892 
seems  excellent  in  principle,  as  the  State 
can  have  no  interest  in  investigating  deaths 
not  due  to  violence.  The  only  defect  is 
that,  without  a  medical  examination  or  in- 
quiry, it  is  impossible,  in  most  cases,  to 
determine  whether  death  is  due  to  violence 
or  not ;  and  a  knowledge  of  the  cause  of 
death  is,  in  most  instances,  the  fir^t  step 
necessary. 

PRELIMINARY    MLDICAL    EXAMIXATH  LX. 

In  the  United  States  this  fact  is  taken 
advantage  of,  and  the  preliminary  exam- 
ination is  always  made  b}'  a  medical  man. 
Most  of  the  American  and  Canadian  cor- 
oners are,  on  this  account,  physicians  ;  and 
when  such  is  not  the  case,  are  provided 
with  medical  officers  who  make  the  pre- 
liminary enquiry.  The  result  being,  that 
;  inquests  are  only  held  upon  violent  deaths. 

AUTOPSIES. 
The  best  results  are  obtained  when  an 
autopsy  is  permissible  at  the  preliminary 
inquiry.  In  Massachusetts,  in  spite  of  the 
fact  that  nearl}'  $40  is  paid  for  each  autopsy, 
the  average  cost  of  investigating  suspicious 
deaths  is  $12.80,  or  $10  less  than  in  Mon- 
treal ;  and,  in  New  York,  the  average  cost 
of  each  death  investigated  is  only  $10; 
including  all  the  expenses  of  conducting 
the  Coroner's  Court. 


THE   CANADA   MEDICAL    RECORD. 


12- 


The  Quebec  law,  instead  of  attempting 
to  utilize  the  medieal  examination  as  a 
means  of  reducing  expenses,  has  avoided 
all  medical  evidence  as  much  as  possible, 
and  has  placed  so  many  restrictions  upon 
the  performance  of  autopsies  that  the  num- 
ber of  these  has  been  reduced  to  a  mini- 
mum. This  has  had  the  undesired  effect 
of  giving  a  very  unsatisfactory  service, 
without  securing  the  economy  aimed  at,  as 
may  be  judged  from  the  fact  that,  in  Lon- 
don, where  autopsies  are  ordered  in  fifty 
per  cent,  of  all  the  deaths  investigated,  the 
average  cost  is  only  $15.35  ^^^  each  case; 
while,  in  Montreal,  with  autopsies  in  only 
1 3  per  cent,  of  the  cases,  the  cost  has  aver- 
aged $22.28. 

During  the  period  from  January  ist  to 
September  30th,  there  were  301  deaths  in- 
vestigated in  the  district  of  Montreal.  The 
expense,  after  deducting  $150  allowed  for 
my  trip,  amounted  to  $6,705.85,  or  $22.28 
for  each  case  investigated  ;  in  spite  of  the 
fact  that  no  medical  fees  at  all  were  paid 
in  98  cases,  or  nearly  one-lhird  of  the 
whole. 

Of  this  sum,  $295,  or  an  average  of  98 
cents  for  each  case,  was  directly  spent  for 
autopsies,  this  amount  representing  the 
additional  fee  of  $5  over  the  cost  of  an  ex- 
ternal examination  ;  and  the  full  fee  of  $10 
in  17  cases,  where  external  examination 
fees  w^ere  paid  to  other  medical  witnesses, 
and  the  official  physician  called  simply  to 
do  the  autopsy.  After  deducting  this  $295 
and  also  $200  charged  to  chemical  analyses, 
arising  indirectly  out  of  the  results  of  the 
autopsies  from  the  total  expense  ($6,705.- 
85),  there  remain  $6,210.85,  or  $20.63 
spent  on  an  average  in  each  case  for  cor- 
oners' and  physicians'  fees,  constables'  fees, 
clerk  hire,  transport  and  care  of  bodies, 
rent  of  rooms,  mileage  and  other  incidental 
expenses  before  the  investigation  had 
reached  a  stage  when  an  autopsy  could  be 
legally  authorized  : — much  more  than  is 
spent  for  the  entire  investigations  in  Lon- 


don, although  autopsies  are  performed 
there  in  50  per  cent,  of  all  the  cases.  This 
looks  rather  as  if  article  2689  led  to  twenty 
dollars  being  spent  in  every  ten  dollars 
saved.  In  1890-92,  the  average  cost  of 
240  inquests  held  yearly  was  $22  50  each, 
of  which  '}^J  cents  was  directly  paid  for 
autopsies. 

On  the  other  hand,  the  early  perform- 
ance of  an  autopsy  would  certainly  have 
shown,  in  half  the  cases,  that  no  grounds 
existed  for  holding  an  inquest,  and  so  have 
saved  a  large  number  of  inquests  ;  the 
average  cost  of  which  was  more  than  double 
that  of  an  autopsy,  while  the  verdicts  were 
often  absurdly  at  variance  with  the  facts 
(or  absence  of  facts)  elicited  by  the  enquiry. 

It  is  evident  that  too  large  a  proportion 
of  the  money  spent  in  Montreal  for  Cor- 
oners' investigations  is  frittered  away  in 
fees  and  expenses  (which  may  be  perfectly 
legal  and  permissible  under  the  law,  but 
are  absolutely  useless  in  furthering  the  in- 
vestigation), and  this  has  led  to  an  undesir- 
able economy  in  which  the  real  objects  of 
the  enquiry  are  lost  sight  of 

As  some  doubt  existed  as  to  the  power 
of  the  Province  to  pass  a  statute,  authoriz- 
ing the  performance  of  autopsies  as  a  pre- 
liminary means  of  investigating  deaths 
from  unknown  causes,  under  suspicious 
circumstances,  I  have  made  careful  enqui- 
ries on  the  subject  of  the  Department  of 
Justice  at  Ottawa.  I  was  informed  the 
Province  has  a  perfect  right  to  authorize 
this,  and  that  there  is  nothing  in  British  or 
Canadian  criminal  law  to  prevent  it,  or 
render  it  inadvisable. 

I  am  not  advocating  the  indiscriminate 
and  wholesale  performance  of  autopsies 
when  they  are  not  needed  to  show  whether 
death  was  due  to  violence  or  not  ;  but  no 
restriction  should  be  placed  upon  their 
being  made  when  really  called  for. 

Lven  without  autopsies,  a  preliminary 
inquiry  and  view  of  the  body  often  yield 
satisfactory  information  that  death  has  been 


124 


THE   CANADA   MEDICAL   RECORD. 


natural,  in  cases  which   seem  suspicious  to 
persons  not  having  a  medical  training. 

In  American  cities,  where  official  med- 
ical experts  are  attached  to  the  Coroner's 
Court,  no  fees  are  paid  to  other  medical 
witnesses.  In  England  no  fees  are  paid  to 
medical  officers  of  public  institutions  in 
connection  with  deaths  occurring  in  them. 
In  all  American  cities  as  large  as  Montreal, 
the  coroner  and,  usually,  the  official  phy- 
sician are  paid  fixed  salaries.  There  were 
no  complaints  that  the  work  was  neglected 
on  this  account. 

MEDICAL    FEES. 

In  the  Quebec  tariff"  there  is  no  fee  ar- 
ranged for  medical  evidence  apart  from 
that  obtained  from  examination  of  the 
body'  and  there  is  no  arrangement  at  all 
for  paying  medical  fees  where  inquests  are 
not  held. 

Independent  of  the  examination  of  the 
body,  the  information  furnished  by  physi- 
cians who  have  seen  the  deceased  during 
life  is  often  of  much  value.  Without  this  it 
is  often  impossible  to  give  a  correct  opinion 
as  to  the  cause  of  death,  even  after  an 
autopsy,  and  the  testimony  of  physicians 
who  have  attended  the  case  often  enables 
an  autopsy  to  be  dispensed  with. 

While  some  provision  is  needed  to  ensure 
that  all  medical  opinions  should  be  founded 
on  facts  which  bear  them  out,  and  that  such 
opinions  are,  generally,  more  correct  when 
given  by  an  expert,  it  is  equally  true  that 
all  medical  testimony  at  inquests,  whether 
of  »fact  or  opinion,  is,  in  a  sense,  expert 
evidence,  and  is  recognized  and  paid  for  as 
such  in  our  Courts. 

It  has  been  found  elsewhere  that  proper 
use  of  medicalevidence  forms  the  best  means 
of  avoiding  unnecessary  inquests  with- 
out running  a  risk  of  serious  mistakes,  and 
any  arrangementtcnding  to  secure  such  evi- 
dence, before  an  inquest  is  decided  upon 
would  certainly  lead  to  economy. 

The  presence  of  a  medical  attendant  at  an 


autopsy  is  often  of  the  greatest  assistance 
to  the  expert  performing  it  ;  and  affords 
the  additional  security  that  the  medical 
evidence  in  Court,  subsequently,  will  not 
suffer  in  case  of  absence  or  death  of  the 
official  physician.  For  this  reason  a  special 
fee  is  provided  in  States  where  the  medical 
examiner  system  has  been  adopted  for 
physicians  acting  as  witnesses  at  autopsies. 

In  addition,  it  has  been  found  in  the 
United  States  that  a  written  statement  of 
medical  fact  or  opinion  by  a  medical  man 
usually  suffices  for  the  purposes  of  an  in- 
quest, so  that  his  personal  attendance  is 
seldom  necessary.  This  privilege  is  highly 
appreciated  by  the  medical  profession,  and 
the  legal  officials  did  not  consider  that  the 
interests  of  justice  suffer.  Of  course,  in  all 
cases  when  the  presence  of  a  physician  at 
an  inquest  is  necessary  it  must  be  insisted 
upon. 

I  think  it  would  be  well  to  provide  a 
special  fee,  say  $2.  for  a  verbal  or  written 
statement  of  medical  facts  or  opinion  with- 
out examination  of  the  body,  and  without 
attendance  at  an  inquest ;  also  to  pay  a 
separate  fee  of  say,  $1  for  attendance  of  a 
physician  at  an  inquest  or  autopsy.  The 
medical  examiner  would  probably  be  the 
best  judge  of  when  and  to  what  extent 
outside  medical  evidence  or  assistance  is 
necessary. 

I  did  not  find  that  the  practice  of  obtain- 
ing medical  evidence  ^r^'Z/j  led  to  any  good 
results.  Unless  the  co-operation  of  physi- 
cians .  is  secured  in  preliminary  inquiries, 
unnecessary  inquests  ha\e  to  be  held  at  a 
much  greater  expense  than  is  incurred  by 
a  medical  fee. 

VIEW  oi'   r.ODV.  , 

The  view  of  the  body  by  non-medical 
persons  appears  to  be  a  perfectly  useless 
proceeding.  Such  persons  constantly  detect 
external  signs  of  violence  where  none  exist, 
or  overlook,  or  fail  to  understand  them 
when    present.     Thj.s    is    constantly    seen 


THE   CANADA   MEDICAL   RECORD. 


125 


under  the  present  regulations  which  neces- 
sitate the  jury  viewing  all  bodies,  and  brings 
about  so  much  unnecessary  intrusion  upon 
households  in  mourning. 

Doing  away  with  the  view  by  the  jury  has 
now  become  general  in  the  United  States, 
and  has  the    advantage  of  enabling  all  in- 
quests to  be  held  at    convenient  hours  in  a 
central  locality,  besides    saving  the  cost  of 
transport  in  all  cases  where  this  is  not  ne- 
cessary for  the  purpose  of  medical  examina- 
tion, and  enabling  the    body  to  be  buried 
as  soon  as  the  medical  examination  is  com- 
pleted.    In  addition,  as    the  jury  do  not 
have  to  be  summoned  before  the  evidence 
is  complete,  an  adjournment  is  seldom  ne- 
cessary.    The  establishment  of  the  fact  of 
death    and    identity  by    sworn    testimony 
fulfils  everything  that  is   attained  through 
the  view  by  the  jury.     I   learned    at  the 
Department  of  Justice  that  the  view  by  the 
jury  forms  no   part  of  criminal    procedure, 
and  is  not  necessary  in  order  to   legalize  a 
verdict  of  homicide  in  Canada. 

MEDICAL  EXAMINER  SYSTEM. 

Nearly  all  the  difficulties  in  connection 
with  Coroner's  law  arise  from  the  fact  that 
it  is  attempted  to  place  both  medical  and 
legal  powers  and  duties  in  the  hands  of  one 
individual,  who  very  often  knows  little  or 
nothing  about  either  law  or  medicine. 

A  solution  of  the  problem  appears  to 
have  been  found  in  the  United  States,  by 
separating,  as  far  as  possible,  the  medical 
and  legal  sides  of  the  investigation,  leaving 
all  medical  matters  to  competent  physi- 
cians, known  as  Medical  P^xaniiners  ;  and 
all  legal  matters,  either  to  the  regular  judi- 
cial and  police  authorities  in  Massachusetts, 
or  to  coroners  having  legal  knowledge  in 
Connecticut. 

It  seems  sufficiently  obvious  that  the 
deciding  whether  a  death  is  due  to  violence 
or  not  is  a  purely  medical  matter,  and 
deciding  whether  the  violence  is  criminal 
or  not,  a  purely  legal    one.     Further,  that 


until  death  has  been  shown  to  be  due  to 
violence  there  is  no  legal  question  at  all. 
For  this  reason,  the  preliminary  investiga- 
tion is  made  by  the  Medical  Examiner ; 
who,  if  he  is  satisfied  that  death  is  due  to 
violence,  or,  if  he  is  in  doubt,  refers  the  case 
to  the  legal  authorities  for  further  investiga- 
tion. 

I  have  given,  in  the  appendix,  details  of 
the  "  Medical  Examiners'  "  systems  and 
their  results.  The  Connecticut  law,  which 
provides  for  medical  examiners,  acting 
under  the  direction  of  the  Coroners,  appears 
to  me  the  best ;  and  could  be  adopted 
almost  as  it  stands  by  the  Province  of 
Quebec,  with  the  effect  of  greatly  improv- 
ing medico-legal  investigations ;  and,  at 
the  same  time,  materially  lessening  the 
expenses. 

In  Massachusetts,  Coroners  have  been 
abolished,  with  very  happy  results  ;  and 
this  could  be  done  in  Quebec,  if  desired,  as 
the  office  is  not  constitutional  in  Canada, 
If  the  office  is  retained,  it  should  be  so 
regulated  as  to  give  better  results  than 
would  be  obtained  without  Coroners. 

It  is  preferable  to  make  the  medical  ex- 
aminer, to  some  extent,  independent  of  the 
Coroner ;  instances  have  come  before  my 
notice  where  Coroners  have  tried  to  compel 
the  medical  deputies  to  give  certain  opi- 
nions not  justified  by  the  facts,  or  have 
prevented  them  from  doing  their  work 
thoroughly.  The  Coroner,  however,  should 
have  the  right  to  investigate  any  case  not 
considered  suspicious  by  the  Medical  Ex- 
aminer, if  he  sees  fit. 

A  joint  preliminaiy  examination  by  the 
Coroner  and  Medical  Examiner  appears  to 
be  the  best  means  of  proceeding  in  cases 
not  obviously  due  to  natural  causes.  As  a 
large  number  of  the  deaths  reported  as 
suspicious  are  always  found  due  to  natural 
causes,  the  Coroner  would,  in  these  cases, 
have  almost  nothing  to  do  ;  and,  in  many 
deaths,  especially  by  those  from  accidents, 
where  the  cause  of  death  was  perfectly  plain. 


126 


THE   CANADA  MEDICAL   RECORD. 


a  careful  inquiry,  by  the  Coroner,  into  the 
outside  circumstances  might  be  necessary. 

On  this  account,  if  a  joint  inquiry  were 
made,  either  the  Coroner  or  Medical  Ex- 
aminer would,  in  many  cases,  have  very 
little  work  ;  and,  therefore,  a  reduced  fee 
paid  in  all  cases  would  be  fair  to  both.  One 
Coroner  could  easily  tak'c  charge  of  a  dis- 
trict requiring  several  Medical  Examiners  ; 
and,  in  the  country,  where  the  outside  cir- 
cumstances are  readily  ascertained,  the 
medical  examiner  might  take  entire  charge 
of  the  preliminary  investigation,  only  noti- 
fying the  Coroner  when  the  case  proved 
really  suspicious.  In  the  country,  we  have, 
already,  medical  men  now  acting  as  Cor- 
oners who  could  be  appointed  Medical  Ex- 
aminers, 

It  is  very  important  that  the  Medical 
Examiner  should  make  mqniry  into  medical 
matters,  in  addition  to  examining  the  body, 
and  should  aid  the  Coroner  in  making  any 
medical  enquiries.  In  any  case,  the  first 
thing  to  be  established  is  whether  death  is 
due  to  violence  or  not,  before  the  legal 
question  of  responsibility  can  be  considered 
at  all. 

Juries  should  only  be  summoned  when 
their  assistance  is  really  necessary.  It 
seems  safer  to  call  them  in  all  cases  of 
homicide  and,  possibly,  of  suicide,  but  their 
real  usefulness  would  lie  in  considering 
cases  supposed  to  be  due  to  negligence, 
especially  railway  and  industrial  accidents. 
The  verdicts  given  in  such  cases,  though 
they  never  result  in  a  conviction  for  homi- 
cide, no  doubt  indirectly  tend  to  ensure 
public  safety. 

In  many  parts  of  the  United  States  in- 
quests are  held  privately,  but  this  plan 
would  scarcely  be  tolerated  here.  Publicity, 
by  juries,  is  a  protection  to  a  Coroner,  as 
the  blame  for  any  mistake,  of  course,  rests 
with  the  jury. 

DEATH  FROM    NATURAL  CAUSES. 

Respecting  the  large  number  of  natural 
deaths    reported    as  suspicious,    it  may  be 


said  that  the  proportion  they  form  in 
Montreal  cases,  viz.,  42  p.c,  is  not  unusually 
high  ; — the  number  in  New  York  being  68 
p.c,  in  Philadelphia  72  p.c,  in  Liverpool 
72.3  p.c,  in  Charleston  ']']  p.c,  and  in  Chi- 
cago 47  p.c.  In  Boston  they  form  36.6  p.c. 
The  best  means  of  excluding  these  cases 
from  Coroners'  Courts  is  by  establishing 
some  good  system  of  registration  of  deaths, 
and  enforcing  a  preliminary  medical  inves- 
tigation by  the  Local  Boards  of  Health  into 
deaths  not  properly  certified,  before  report- 
ing them  to  the  Coroner.  I  am  glad  to 
learn  that  there  is  a  prospect  of  the  charter 
of  the  city  of  Montreal  being  amended  in 
this  respect  during  the  present  session. 

CON'CLUSION. 
In  conclusion,  I  have  only  to  state  that,  in 
my  opinion,  what  is  needed  to  improve  the 
Coroner's  Court  of  the  Province  of  Quebec 
is  the  introduction  of  a  law  similar  to  that 
now  existing  in  Connecticut,  providing  for 
coroners  with  legal  knowledge  and  official 
medical  examiners,  with  definite  instruc- 
tions as  to  the  duties  of  both. 
I  would,  therefore,  respectfully  suggest : — 

1.  The  appointment,  in  each  district, 
of  official  medical  examiners,  to  determine 
whether  death  is  due  to  violence  or  not  ; 
and  of  magistrates  or  lawyers,  as  coroners, 
to  decide  whether  such  violence  is  criminal 
and  calls  for  inquest  before  a  jury. 

2.  A  preliminary  inquiry  and  examina- 
tion of  the  body  in  all  cases  reported  ;  made 
jointly  by  the  medical  examinerand  coroner 
in  cities,  and  by  the  medical  examiner  alone 
in  rural  districts  ; — the  facts  obtained  to  be 
recorded  in  writing. 

3.  Autopsies  to  be  ordered  when  the 
cause  of  death  is  unknown  and  the  circum- 
stances of  the  death  suspicious.  Juries  to 
be  summoned  when  evidence  is  obtained 
pointing  to  criminal  violence. 

4.  Salaries  to  be  substituted  for  fees  in 
the  case  of  large  cities. 

If  desired  to  do  so,  I  am  prepared  to 
frame  an  Act    which  will  j^rovide  for  this 


TtlE   CANADA   MEDICAL   RECORD. 


127 


system  of  investigation  ;  but  it  appears  to 
me  that  the  Connecticut  law  is  almost 
exactly  what  is  required.  Even,  under  the 
present  law,  a  preliminary  inquiry  would 
greatly  improve  matters. 

Attempts  at  economy,  by  trying  to  do 
away  with  the  medical  investigation,  have 
only  resulted  in  producing  a  system  which 
is  so  inefficient  as  to  be  a  constant  subject 
of  public  ridicule,  which  makes  the  average 
investigation  much  more  expensive  than 
in  London,  Massachusetts  or  New  York, 
and  which  has  not  yet  trained  in  this  Pro- 
vince any  official  whose  experience  in  med- 
ico-legal examinations  is  sufficient  to  make 
his  opinion,  as  an  expert,  of  much  value. 

If  the  useless  fees  and  expenses  now 
made  necessary  by  the  "  pomp  and  cir- 
cumstance "  of  coroners'  inquests  were  dis- 
pensed with,  a  more  efficient  service  would 
be  obtained  and  less  money  spent. 

I  have  the  honor  to  be, 

Your  obedient  servant, 
WYATT  JOHNSTON. 
Montreal,  November  21st,  1893. 

§0cietg     moccct^mgs. 

MONTREAL      MEDICO-CHIRURGICAL 
SOCIETY. 

Stated  Meeting,  November  TyOth,  1894. 

G.  P.  GiRDwooi),  M.D.,  President,  in  the 
Chair. 

Drs.  J.  A.  Henderson  and  E.  D.  Aylen  were 
elected  ordinary  members. 

Two  Cases  of  Skin  Grafting. — Dr.  Arm- 
strong showed  a  man  and  a  boy  on  whom  he 
had  recently  performed  the  operation  of  skin 
grafting. 

The  boy,  aged  16,  was  burned  in  rather  an 
unusual  way  some  time  before.  A  gentleman 
walking  along  the  street  in  front  of  him,  after 
lighting  a  cigar,  had  thrown  the  match  behind, 
and  ignited  the  boy's  clothes,  severely  burning 
him  about  the  arm  and  cliest. 

The  cicatrix  follov/ing  the  burn  had  bound 
the  arm  to  the  chest,  in  such  a  manner  that  he 
had  only  the  use  of  his  forearm,  and  the  opera- 
tion was  undertaken  to  relieve  this   condition. 


The  arm  was  freed  by  dividing  the  cicatrix, 
and  it  and  the  corresponding  side  of  the  chest 
were  grafted  with  skin  taken  from  other  parts 
of  the  body.    • 

The  result  was  very  good  ,  the  arm  and 
chest,  including  even  tlie  axilla,  over  the  area 
corresponding  to  the  cicatrix,  were  now 
covered  with  healthy  skin,  and  tlie  upper  arm 
was  qm'te  inoveab'e.  Sensation  over  the  grafted 
area,  while  not  perfect,  was  all  that  could  be 
expected,  and  was  improving  daily.  Sensation 
in  these  cases  first  appeared  at  the  periphery 
and  worked  towards  the  centre. 

In  the  case  of  the  man,  there  had  been  malig- 
nant disease  of  the  skin  in  the  region  of  the 
temple,  reported  to  be  endothelioma.  It  had 
ill  the  characteristics  of  a  rodent  ulcer.  Until 
recently,  it  had  been  the  custom  to  wait,  after 
preparing  the  region,  until  granulations  had 
appeared  before  applying  the  graft.  Lately, 
however,  both  time  and  pain  had  been  saved 
by  applying  the  grafts  to  the  raw  surface,  and 
completing  the  whole  operation  at  once.  Dr. 
Armstrong  had  adopted  the  latter  method  in  this 
case,  and  the  result  proved  successful.  He 
covered  the  area,  which  appeared  to  be  about 
i^  to  2  inches  in  diameter,  and  fully  fi  of  an 
inch  deep,  by  a  single  graft.  At  the  time 
shown,  it  was  almost  on  a  level  with  the  sur- 
rounding surface  and  approaching  nearer  to 
that  point  daily.  He  had  encountered  some 
difficulty  in  rendering  that  portion  of  the  skin 
which  bordered  on  the  hair  of  the  scalp  asep- 
tic, not  being  able  to  obtain  any  chemical 
capable  of  disinfecting  without  destroying  the 
tissues,  and  in  consequence  the  grafting  had 
not  done  quite  as  well  in  this  region.  The 
quality  of  the  skin  appeared  to  be  very  good, 
it  was  quite  moveable  over  the  underlying  tis- 
sue, and  sensation  was  present  at  the  periphery . 
and  increasing  towards  the  centre  daily. 

Dr.  Gordon  Campbell  was  present  at  the 
operation.  At  the  time  it  seemed  to  him  that 
the  patient,  though  benefited  by  removal  of  the 
ulcer,  would  still  be  disfigured  by  the  depres- 
sion in  the  temple,  which,  as  Dr.  Armstrong 
had  stated,  was  fully  }i  of  an  inch  below  the 
surrounding  surface.  The  amount  of  filling  in 
that  had  gone  on  would  hardly  be  credited  b^ 
one  who  had  not  seen  the  previous  condition. 

Aortic  Stenosis  and  Incompetence  tvith  Iri- 
cuspid  1  nvolvement . — Dr.  McConnell  read 
the  report. 

Dr.  Armstrong  remarked  that  the  apparent 
cure  of  the  appendicitis  had  proved  nothing. 
Only  a  short  time  before  he  operated  upon  a 
man  for  this  disease  twelve  hours  after  the 
onset,  and  yet  tlie  operation  was  too  late  to 
save  the  patient.  He  had  had  previous 
attacks,  but  had  been  free  from  any  for  the 
past  fifteen  years. 

Dr.  James  Bell  had  a  student  now  under 
his  care  in  the  hospital  who  had  an  attack  of 


128 


THE    CANADA   MEDICAL   RECORD. 


appendicitis  about  15  years  ago.  He  recover- 
ed without  operation,  and  feit  no  further  trou- 
ble until  about  three  months  ago,  since  which 
time  he  has  had  five  different  attacks. 

Dr.  Lafleur  after  examining  the  condition 
of  the  heart  failed  lO  see  any  tricuspid  involve- 
ment, the  valve  appeared  perfectly  normal. 
He  did  not,  therefore,  think  Dr.  McConnell's 
diagnosis  borne  out  in  this  respect. 

Dr.  FiNLEV  thought  the  presystolic  murmur 
here  might  be  explained  on  Dr.  Austin  Flint's 
theory,  that  in  a  certain  number  of  cases  of 
aortic  regurgitation,  a  presystolic  murmur 
heard  at  the  apex  was  the  result  of  the  floating 
upwards  of  the  mitral  segments,  thus  narrow- 
ing the  orifice,  and  producing  this  sound. 

Notes  on  a  Cerebral  Tumor. — Dr.  James 
Stewart  read  a  paper  on  this  subject. 

Dr.  C.  E.  Cameron  said  this  patient  had 
come  under  his  care  two  years  ago  last  sum- 
mer. At  that  time  he  had  hallucinations  ;  he 
thought  some  beasts,  as  he  called  them,  were 
crawling  round  his  neck,  and  wanted  the  doc- 
tor to  remove  them  ;  he  also  believed  he  had 
worms  in  his  stomach,  which  he  said  w^ere  inter- 
fering with  his  digestion.  Shortly  after  this 
he  took  to  bed,  and  never  left  it  till  he  died. 
Latterly,  he  never  made  any  complaints,  never 
even  sought  his  meals;  he  lived,  but  his  life 
was  more  like  that  of  a  vegetable,  than  animal. 
He  lost  control  of  his  sphincters  during  the 
last  year. 

Dr.  Shepherd  regretted  that  Dr.  BuUer  was 
not  present,  as  he  had  for  some  years  under 
his  care  a  patient  suffering  from  a  tumor  not 
unlike  this.  It  grew  from  the  pituitary  body, 
and  after  lasting  some  years,  involved  the  eth- 
moid and  the  palate  bones,  until  you  could 
finally  see  the  tumor  through  the  mouth. 
The  specimen  existed  in  the  museum  of  McGill 
University. 

Dr.  Mills  regretted  that  the  condition  of  the 
brain  was  so  far  advanced  in  decomposition  at 
the  time  of  the  autopsy,  otherwise  he  believed 
the  microscope  should  reveal  some  other 
degenerated  conditions  besides  the  presence  of 
this  tumor  to  account  for  all  the  symptoms  in 
the  case.  Of  course  it  was  possible  that  the 
connection  of  the  tumor  with  the  pituitary 
bo*dy  was  capable  of  causing  all  these  complex 
symptoms.  Some  said  that  this  organ  was 
allied  to  the  thyroid,  and  being  a  blood  viscus 
it  might  explain  the  anaemia.  It  would  at  any 
rate  be  important  to  ascertain  definitely  whe- 
ther or  not  the  pituitary  body  was  involved 
in  the  tumor,  and  if  it  was,  many  of  the  symp- 
toms could  be  explained. 

Dr.  Adami,  replying  to  Dr.  Mills'  remarks, 
said  he  had  looked  carefully  through  a  large 
number  of  sections  taken  from  that  region,  but 
had  been  unable  to  find  any  i)ituitary  sub- 
stance, which  had  apparently  completely  atro- 
phied. 


End  to  End  Anastomosis  of  Intestines  by 
means  of  the  Murphy  Button. — Dr.  James 
Bell  read  a  paper  as  follows  : 

I  am  able  to  report  three  cases  in  which  I 
have  used  the  Murphy  button  to  secure  end  to 
end  union  of  intestine  after  resection.  In  two 
the  results  were  completely  successful  and 
most  satisfactory.  In  one  thus  made  there 
was  non-union,  sloughing  of  the  apposed  ends 
of  the  bowel,  escape  of  contents,  and  death 
from  peritonitis.  Two  of  the  three  operations 
were  upon  the  same  patient,  and  it  was  the 
second  operation  upon  this  patient  which 
proved  fatal.  I  am,  therefore,  enabled  to  pre- 
sent .specimens  showing  (i)  the  union  which 
had  resulted  from  the  first  operation,  as  well 
as  (2)  the  sloughing  of  the  bowel  which 
resulted  from  the  second  operation.  This  case 
is,  moreover,  a  most  interesting  and  puzzling 
one  from  a  pathological  standpoint,  although  I 
wish  for  the  present  to  direct  attention  spe- 
cially to  the  use  of  the  Murphy  button. 

The  second  case  was  one  of  femoral  hernia, 
in  which  39  hours  of  strangulation  had  pro- 
duced complete  gangrene  of  the  extruded  loop 
of  bowel.  Until  very  recently  such  cases  were 
the  bete  noire  of  the  surgeon,  and  the  question, 
"  What  shall  be  done  with  cases  of  gangrenous 
hernia?"  has  been  much  discussed.  This 
case  and  others,  now  a  goodly  number,  of  re- 
coveries after  resection  of  the  bowel,  indicate 
the  only  rational  treatment,  and  it  is  particu- 
larly in  this  very  class  of  cases,  where  rapidity 
of  operation  is  frequently  such  an  important 
consideration,  that  artificial  aids  are,  if  useful 
at  all,  of  the  greatest  service. 

(Jase  I. — J.  W.  McC,  male,  a^t.  40,  had 
always  enjoyed  good  health  until  June,  1893, 
when,  while  in  Chicago  attending  the  World's 
Fair,  he  was  suddenly  seized  with  severe  and 
painful  diarrhoea,  The  diarrhcca  subsided  in 
four  or  five  days,  but  pain  remained,  and  he 
felt  so  badly  that  he  came  home  and  was  un- 
able to  work  for  six  weeks.  His  bowels  had 
never  been  quite  regular  since  this  attack. 
He  recovered  fairly  well,  however,  until  Dec- 
ember, 1893,  when  he  had  another  attack  of 
pain  and  a  haemorrhage  from  the  boweF'. 
Since  that  time  he  had  never  had  a  natural 
movement  of  the  bowels  without  a  i)urgative, 
and  he  had  suffered  greatly  from  wind,  which 
after  rumbling  about  for  some  lime  finally 
escaped  in  an  explosive  manner,  giving  great 
relief.  In  February,  1894.  he  was  seized  with 
faintness,  and  some  hours  afterwards  passed  a 
large  quantity  of  blood  per  rectum.  A  similar 
attack  had  occurred  once  since.  On  the  14th 
June,  1893,  he  was  admitted  to  the  Royal  Vic- 
toria Hospital,  with  complete  obstruction  of 
the  bowels  of  six  days'  standing,  and  for  which 
he  had  been  given  various  kinds  of  purgatives, 
as  well  as  enemata,  but  without  any  effect. 
His     abdomen    was  greatly    distended.      The 


THE  CANADA  MEDICAL  RECORD. 


129 


principal  distress  was  referred,  vaguely,  to  tbe 
hypogastrium,  and  bimanual  examination 
(with  a  finger  in  the  rectum)  discovered  an 
ill-defined  mass  in  the  middle  line,  about  mid- 
way between  the  umbilicus  and  ihe  ])ubes. 
This  examination  gave  a  good  deal  of  pain,  and 
was  followed  by  the  passage  of  a  little  flatus 
and  soon  afterwards  by  a  liquid  stool.  The 
symptoms  were  at  once  relieved,  and  free 
evacuation  of  liquid  freces  continued  for  two 
or  three  days.  He  remained  well,  with  the 
exception  of  the  wind  and  constipation,  which 
was  relieved  from  time  to  time  by  purgatives 
until  the  14th  of  July,  when  he  «as  seized  with 
faintness,  and  became  quite  pale.  This  con- 
dition lasted  all  the  afternoon,  and  the  palietit 
stated  that  he  knew  from  his  past  experiences 
th?t  he  was  about  to  have  a  Im^morrhage,  and 
within  a  few  hours  a  large  quantity  of  dark 
clotted  blood  was  passed  per  rectum.  I  now 
advised  operation,  to  which  he  readily  con- 
sented, and  on  the  19th  of  July  I  opened  the 
abdomen  in  the  middle  line  below  the  umbili- 
cus and  directly  over  the  part  at  which  the 
mass  had  been  felt,  although  it  had  disap- 
peared widi  the  free  evacuation  of  tiie  bowels 
and  had  not  since  been  discoverable.  Tvvo 
loops  of  small  intestine,  each  acutely  bent 
upon  itself,  were  found  attached  to  a  mass 
which  overhung  the  brim  of  the  ])elvis.  These 
were  carefully  separated,  when  it  was  found 
that  they  both  communicated  with  a  free  cav- 
ity, bounded  posteriorly  by  the  mass  above 
mentioned,  and  in  which  lay  a  long  irregular 
mass  of  inspissated  faecal  matter.  The  ob- 
struction was  at  the  upper  of  the  two  acutely 
bent  portions  of  the  ileum,  and  the  bowel 
above  this  angle  was  three  times  as  large  as  it 
was  below  it.  Over  a  space  of  two  inches  in 
length,  and  involving  one-third  of  the  circum- 
ference of  the  bowel,  the  wall  of  the  gut  was 
entirely  absent.  This  portion  was  excised  and 
the  ends  united  by  the  Muiphy  button.  At 
the  lower  attached  loop  the  destruction  of  the 
bowel  was  less,  being  about  one  inch  in 
length,  and  involving  a  narrow  strip  along  the 
mesenteric  border.  These  deficiencies  in  the 
wall  of  the  bowel  were  apparently  the  result  of 
a  destructive  ulcerative  process.  It  was  from 
this  point  that  the  haemoiihages  had  occurred, 
and  a  small  aitery,  which  was  ulcerated 
through,  bled  very  freely.  The  vessel  was 
ligatured  and  the  opening  in  the  bowel  closed 
by  a  continuous  Lembert  suture  running  ob- 
liquely from  the  mesenteiic  border  to  near  the 
free  border  of  the  bowel.  This,  of  course,  nar- 
rowed the  lumen  of  the  gut  somewhat,  and 
gave  me  some  anxiety  as  to  the  possibility  of 
the  passage  of  the  button,  which,  it  will  be 
noted,  was  on  the  proximal  side  of  this  sut- 
ure. My  only  alternative,  however,  was  an- 
other resection  and  end  to  end  anastomosis, 
and  I  decided  to   leave  it  as  it  was,  as  I  had 


still  to  turn  my  attention  to  the  mass  over- 
hanging the  i)elvis,  and  which  had  been  in  such 
intimate  relation  with  the  bowel  already  oper- 
ated upon.  Careful  examination  of  the  mass 
led  me  to  the  conclusion  that  it  was  simply  ci- 
catricial, and  that  it  did  not  involve  any  other 
part  of  the  intestinal  canal.  The  subsequent 
history  shows  that  I  was  wrong  in  the  con- 
clusion arrived  at,  as  to  the  character  of  the 
mass,  but  right  as  to  its  not  then  involving  any 
other  portion  of  the  bowel.  The  patient  made 
an  excellent  recovery,  and  after  a  week  or  ten 
days  his  bowels  moved  regularly  and  he  passed 
large,  well  formed  stools  (showing  that  there 
was  tlien  no  obstruction  in  the  rectum  or  sig- 
moid flexure),  but  the  button  never  came 
away.  With  the  exception  of  some  discom- 
fort after  an  enormous  dinner  of  corned  beef 
and  cabbage  and  several  summer  apples,  he 
continued  well,  and  left  the  hospital  on  the  T2th 
of  August  in  first  rate  condition.  (Rewrote  me 
the  day  after  leaving  the  hospital,  to  say  that 
he  had  not  felt  so  well  for  two  years.)  On  the 
nth  September  he  returned,  again  suffering 
from  obstruction.  He  had  enjoyed  good 
health  for  from  one  to  two  weeks  after  leaving 
the  hospital.  Then  diarrhoea  set  in  for  a  few 
days,  after  which  it  was  succeeded  by  consti- 
pation and  rumbling  of  wind  in  the  intestines, 
ending  as  before  in  painful  and  explosive  eva- 
cuations with  temporary  relief.  This  continued 
until  September  iSih  at  4  p.m.,  when  obstruc- 
tive symptoms  (inability  to  pass  even  flatus, 
vomiting,  etc.)  came  on.  These  were  attri- 
buted by  the  patient  to  the  arrest  and  impac- 
tion of  the  button  (which  had  never  been 
found),  in  some  portion  of  the  ileum  or  large 
intestine.  In  this  condition  he  reached  the 
hospital  on  the  night  of  the  iith  of  September, 
and  on  the  following  day  at  2  p.m.,  forty-six 
hours  after  the  onset  of  the  symptoms,  I  reop- 
ened the  abdomen  through  the  original  median 
incision.  The  button  was  found  free  in  the 
spleenic  flexure  of  the  colon,  and  removed 
through  a  small  incision  on  its  free  surface, 
which  was  closed  by  Lembert  sutures.  I  had 
previously  discovered  the  obstruction  in  the 
lower  portion  of  the  sigmoid  flexure  by  passing 
the  button  down  through  the  descending  colon 
and  attempting  to  expel  it  per  anum.  The 
si'e  of  the  previous  resection  could  only  be 
located  by  the  irregularity  in  the  mesentery, 
and  the  bowel  was  of  uniform  size  above  and 
below  it.  The  mass  overhanging  the  brim  of 
the  pelvis  was  apparently  smaller,  and  was  cer- 
tainly much  more  movable  than  at  the  prev- 
ious operation.  The  site  of  the  obstruction 
having  been  located  in  the  lowermost  portion 
of  the  sigmoid  flexure,  I  proceeded  to  remove 
it,  together  with  the  tumor  overhanging  the 
brim  of  the  pelvis,  with  which  it  was  continu- 
ous. This  was  finally  accomplished  after  some 
difficulty,  owing  to  the  depth  in  the    pelvis  at 


1^0 


THE   CANADA    MEDICAL   RECORD. 


which  the  manipulations  had  to  be  carried  on. 
The  mass,  which  was  dense  and  Iiard,  sur- 
rounded the  bowel  as  a  narrow  band  (about  an 
inch  in  width  externally),  and  nearly  closed  its 
lumen,  leaving  only  a  narrow  slit  about  as  large 
as  a  waistcoat  buttonhole.  It  was  infiltrating, 
and  was  evidently  either  cicatricial  tissue  or 
scirrhus  cancer.  It  has  since  been  demon- 
strated to  be  the  latter.  During  the  operation 
the  bowel  was  occluded  on  either  side  by  a 
piece  of  hollow  rubber  tubing.  About  three 
inches  of  the  bowel  was  removed,  and  the 
ends  united  by  the  largest  sized  Murphy 
button.  The  operation  lasted  aboi.t  two 
hours,  and  was  well  borne.  There  was  little 
loss  of  blood  and  no  fouling  of  the  peritoneal 
cavity.  A  glass  drainage  tube  was  carried 
down  to  the  bottom  of  the  pelvis  and  ex- 
hausted from  time  to  time.  A  small  quantity 
only  of  odorless  fluid — at  first  blood-stained 
and  afterwards  colorless — was  all  that  was 
withdrawn  from  the  tube  for  forty-eight  hours, 
during  which  the  patient  did  typically  well  in 
every  respect.  S'iveral  copious  evacuations  of 
dark  liquid  faeces  occurred,  the  first  about 
three  hours  after  the  completion  of  the  oper- 
ation. There  was  no  vomiting,  the  pulse  ran 
from  88  to  94,  and  the  temperature  from 
98.5  °  to  99.5  °  F.,  and  with  the  exception  of 
the  thirst  and  restlessness  usually  observed 
after  severe  abdominal  operations,  he  was  per- 
fectly comfortable.  About  2  p.m.,  on  the 
14th  (48  hours  after  operation),  the  patient 
WaS  seized  with  very  severe  pain,  which  was 
not  sensibly  relieved  by  a  moderate  quantity 
of  Lig.  opii  sed.  (Battley)  injected  liypoder* 
mically.  The  dressing  was  removed  and  the 
glass  drainage  tube  found  filled  with  liquid 
faecal  matter.  From  this  time  he  sank  rapidly, 
and  died  in  about  18  hours.  Post-mortem  ex- 
amination discovered  a  general  peritonitis, 
with  quantities  of  liquid  fiecal  matter  free  in 
the  peritoneal  cavity.  The  button  remained 
in  situ,  but  the  approximated  ends  of  the 
bowel  were  completely  gangrenous  in  their 
whole  circumference,  and  had  given  way  just 
beyond  the  border  of  the  button.  I  cannot 
offer  any  satisfactory  explanation  of  this  unfor- 
tunate result.  Dr.  Murphy  states,  in  a  letter 
to  me,  that  •'  this  is  an  exceptional  case,"  and 
has  not  occurred  so  far,  except  where  there 
was  infection  from  without,  preventing  the 
union,  and  where  the  post-mortem  showed 
that  there  was  no  effort  at  union  at  any  portion 
of  the  circumference,  as  well  as  at  the  point 
where  the  jK-rforation  occurred.  This  condi- 
tion was  certainly  shown  by  the  post  mortem 
in  this  rase,  but  I  cannot  believe  that  it  was 
primarily  due  to  infection  from  without.  I 
cannot  believe  that  with  such  symptoms  as  I 
have  narrated  in  the  history  of  ihe  first  forty- 
eight  hours  after  operation  there  could  have 
been  infection  from  without.     I  am  much  more 


inclined  to  attribute  it  to  one  of  two  things, 
either  (i)  impairment  of  the  vitality  of  the 
ends  of  the  bowel  by  the  use  of  the  elastic 
ligature;  or  (2)  pressure  upon  the  wall  of  the 
bowel  between  the  end  of  the  glass  drainage 
tube  externally  and  the  button  internally,  pro- 
ducing erosion  and  escape  of  intestinal  con- 
tents, and  then  infection  from  without.  Fin- 
ally, it  is  perhaps  open  to  question,  whether 
the  viialisy  of  the  bowel  was  not  already  im- 
paired by  its  great  distension  about  the  stric- 
ture, and  also  whether,  considering  the  thick- 
ness of  the  wall  of  the  bowel  in  this  situation, 
the  button  may  not  have  been  closed  too 
tightly. 

Case  II. — Mrs.  M.,  cet  49  ;  strangulated 
femoral  hernia.  Operation  in  the  Royal  Victo- 
ria Hospital,  October  20th,  1894,  at  ti  a.m., 
thirty-nine  hours  after  onsa  of  symptoms.  The 
patient,  a  stoutly  built  woman,  had  always  en- 
joyed good  health.  About  fifteen  years  ago  a 
hernia  first  appeared  in  the  right  fermoral 
region.  It  had  ahvays  been  reducible,  and  had 
never  given  her  much  trouble.  She  had  not 
worn  a  truss.  Symptoms  of  strangulation  came 
on  about  8  o'clock  in  the  evening  (October 
iSih),  severe  pain,  swelling  of  the  mass,  which 
could  not  be  ^•educed,  great  tenderness  (a  spe- 
cially marked  symptom),  and  frequent  vomiting 
which  soon  became  fa;cal  in  character.  On 
adiTiission  these  symptoms  .persisted,  but  in  a 
modified  degree.  The  pulse  was  96  and  the 
temperature  loo'F.  The  abdomen  was  mod- 
erately distended.  No  attempt  was  made  to 
reduce  the  hernia.  On  making  the  incision 
through  the  skin  and  fascia,  brownish, serum 
exuded  from  the  cellular  tissue  having  a  strong- 
ly ])utrefactive  odor.  The  sac  was  greatly 
thickened,  dark,  cedematous  and  friable,  and 
contained  a  couple  of  drams  of  dark  blood- 
stained serum,  which  also  gave  off  a  strong  odor 
of  pulrefiiction.  The  hernia  consisted  of  about 
three  inches  of  ileum  tightly  caught  and  quite 
gangrenous.  When  the  opening  was  enlarged 
by  incision  of  Gimbernat's  ligament  and  healthy 
bowel  brought  down,  the  gangrenous  part  lay 
collapsed  and  empty,  and  almost  separated 
from  the  healthy  gut  at  both  ends  where  it  had 
been  constricted.  The  bowel  was  emptied  and 
compressed  by  the  fingers  of  an  assistant,  and 
six  and  a  half  inches  removed,  and  the  ends 
united  by  the  Murphy  button.  The  mesentery 
corresponding  to  this  portion  had  been  ligated 
off  at  some  distance  from  the  bowel  through 
healthy  tissue.  In  spite  of  the  greatest  precau- 
tions, however,  the  mesentery  stripped  itself 
away  from  the  bowel  at  eitlier  end.  'rhere  was 
no  great  bleeding,  but  I  felt  that  I  could  not 
leave  the  patient  in  that  condition,  for  fear  of 
hemorrhage  in  the  first  place,  and  secondly,  for 
fear  of  sloughing  of  the  bowel  which  had  been 
thus  deprived  of  its  vascular  supply.  I  there- 
fore continued  my  incision   upwards,  and  out- 


THE  CANADA   MEDICAL  RECORD. 


I3t 


wards  through  Poupart's  ligament,  and  opened 
the  abdominal  cavity.  I  again  resected  ;  this 
time  five  inches,  going  well  within  the  border 
of  the  attached  mesentery,  united  the  ends  with 
the  Murphy  button,  ligatured  the  mesenteric 
vessels,  and  brought  the  mesenteric  borders 
together  with  catgut  sutures  close  up  to  the 
bowel.  There  were  thus  1 1  inches  of  bowel 
removed.  The  hernial  sac  was  excised,  and 
the  peritoneal  wound  closed  with  mattress 
sutures  of  silk.  The  muscular  borders  were 
next  closed  with  buried  sutures  of  silk-worm 
gut,  and  the  pectineal  fascia  was  attached  to  the 
reunited  Poui)art's  ligament  by  three  sutures 
of  catgut.  Finally  the  skin  was  closed  by  a 
separate  layer  of  silk-worm  gut  sutures,  and  a 
small  tent  of  iodoform  gauze  introduced  at  the 
lower  angle  of  the  wound.  The  operation 
lasted  two  hours,  and  was  well  borne.  The 
patient  never  had  a  bad  sym[)t()m,  and  made 
an  uneventful  recovery.  A  liquid  motion  (with 
flatus)  was  expelled  at  the  end  of  twenty-four 
hours  (after  administration  of  an  enema).  A 
regular  movement  occurred  again  next  day, 
and  on  the  fifth,  sixth,  ninth  and  tenth  days. 
The  button  was  found  imbedded  in  a  well 
formed  stool,  wiiich  was  passed  at  1.30  p.m., 
October  30th,  just  ten  full  days  after  operation. 
The  wound  was  perfectly  healed,  and  the  pa- 
tient allowed  up  on  the  22nd.  Healing  per 
primam. 

My  experience  in  these  three  cases  leads  me 
to  the  conclusion  that  the  Murphy  button  is  a 
valuable  aid  in  end  to  end  anastomosis  of  in- 
testine. So  many  artificial  aids  have  been  intro 
duced  for  this  purpose,  have  had  their  day  and 
have  been  discarded,  that  most  surgeons  are 
now  sceptical  about  anything  of  this  kind.  It 
is,  of  course,  not  to  be  assumed  that  union  of 
intestine  cmnot  be  secured  without  such  aids, 
for  it  undoubtedly  can  ;  but  the  great  desiderata, 
rapidity  of  operation  and  accuracy  and  secur- 
ity of  co-aptation  are  both  admirably  effected 
by  this  instrument.  I  cannot  agree  with  the 
view  which  has  recently  been  promulgated, 
that  the  Murphy  button  is  useful  in  the  hands 
of  the  tyro  and  is  not  necessary  to  the  expe- 
rienced surgeon.  The  actual  union  of  the  in- 
testinal ends  is  but  one  part  of  the  operation, 
even  if  it  be  the  culminating  point,  and  the 
surgeon  who  is  not  possessed  of  the  necessary 
skill  to  unite  tiie  ends  of  the  intestine  by  suture 
is  certainly  not  fitted  to  undertake  any  such 
operation  by  any  method.  In  my  experience 
the  most  difficult  part  ot  such  operations,  and 
the  part  which  most  requires  surgical  skill,  is 
that  which  is  preliminary  to  the  intestinal  co- 
aptation. Again  the  button  may  be  used  (as 
in  my  second  operation)  deep  down  in  the 
pelvis,  where  accurate  union  by  suture  would  be 
almost  impossible. 

The   great  want  of  intestinal  surgery  at  the 
present  time  is  a  suitable  clamp,  a  clamp  which 


will  occlude  the  lumen  ot  the  bowel,  without 
too  much  pressure  upon  its  delicate  walls,  and 
without  exercising  pressure  upon  the  arterial 
supply  at  the  mesenteric  border.  Dr.  Mur- 
phy's ingenious  contrivance  to  exercise  a  uni- 
form spring  pressure  gives,  I  think,  a  clue 
which  may  be  utilized  to  effect  this  purpose, — 
I  mean  to  produce  a  clamp  to  be  locked  like 
an  ordinary  artery  forceps  (P6an).  with  smooth 
blades  capable  of  being  armed  with  rubber  tub- 
ing, and  upon  a  spinal  spring  which  will  make 
the  pressure  indirect  rather  than  direct  uniform 
and  capable  of  regulation.  I  know  of  no  clamp 
at  present  in  use  which  is  not  open  to  serious 
objection.  The  use  of  rubber  tubing  is,  per- 
haps, open  to  less  objection  than  any  other 
device,  but  it  is  not  by  any  means  satisfactoiy. 
As  it  surrounds  the  bowel,  the  wall  must  be 
puckered  considerably  in  order  to  occlude  the 
canal — especially  in  the  large  intestine — hence 
more  pressure  is  required  than  should  be  nec- 
essary if  applied  so  as  to  evenly  appose  the 
inner  surfaces.  It  also  cuts  off  the  circulation 
for  a  time  completely,  and  the  proper  regulation 
of  the  degree  of  pressure  is  extremely  difficult. 
If  one  could  always  have  the  ideal  assistant,  I 
believe  that  the  best  clamp  is  the  thumb  and 
forefinger,  but  a  serious  objection  to  this  is, 
that  at  best,  the  assistant's  hands  are  greatly  in 
the  way  of  the  operator,  and  worse  still,  there 
is  the  constant  danger  that  by  relaxing  or  mov- 
ing his  fingers  the  contents  of  the  bowel  may 
be  allowed  to  escape  and  prove  disastrous  to 
the  operation. 

THE  BALTIMORE  MEETLNGS. 

THE     AMERICAN    ACADEMY  OF     MEDICINE.       PRE- 
LIMINAkV    PROGRAMME. 

The  twentieth  Annual  Meeting  of  the  Amer- 
ican.Academy  of  Medicine  will  be  held  in  one 
of  the  buildings  of  the  Johns  Hopkins  Univer- 
sity, Baltimore,  on  Saturday,  May  4th,  and  on 
Monday,  May  6th,  1895.  The  "  Headquar- 
ters "  of  the  Fellows  of  the  Academy  and  the 
meetings  of  the  Council  will  be  at  the  "  Staf- 
ford." 

The  meeting  will  open  at  ten  o'clock  on 
Saturday  morning  with  an  executive  session  of 
the  Fellows  of  the  Academy  exclusively  ;  the 
reading  of  the  papers  will  begin  at  about  ele- 
ven. The  morning  session  will  close  at  one 
o'clock,  and  the  session  of  Saturday  afternoon 
will  extend  from  three  to  six.  The  "  Re-union 
Session  "  will  be  held  on  Saturday  evening. 
By  a  standing  rule  the  price  of  the  tickets  for 
the  supper  is  fixed  at  two  dollars.  Attendance 
at  the  reunion  session  is  not  confined  to  the 
fellows  exclusively,  hence  any  member  may 
bring  friends  with  him  by  arranging  for  their 
tickets  with  the  committee.  For  the  past  two 
years  ladies  have  been  present  at  this  session, 
and  have  added  to  the  enjoyment.  The  session 


1-32 


THE  CANADA  MEDICAL   RECORD. 


of  Monday  will  begin  with  a  shorl  executive 
meeting-,  after  which  the  reading  of  papers  will 
be  resumed  ;  after  a  recess  at  one,  tlie  after- 
noon session  will  begin  at  three  and  continue 
until  adjournment. 

Members  of  the  profession,  and  others  who 
may  be  interested  in  the  topics  treated  by  the 
papers,  are  cordially  invited  to  attend  the  open 
sessions  of  the  Academy. 

The  following  are  the  titles  of  the  papers 
that  have  been  promised  : 

1.  The  Address  of  the  retiring  president,  J. 
McFadden  Gaston,  Atlanta,  Ga, 

2.  "  Expert  Testimony,"  Henry  Leffmann, 
Philadelphia. 

3.  "  Hospital  Management,"  W.  L.  Esles, 
South  Bethlehem,  Pa. 

4.  "  The  Pioper  Teaching  of  Physiology  in 
the  Pujlic  Schools  as  a  Means  of  Preventing 
Intemperance  and  Venereal  Disease,"  DeLan- 
cey  Rochester,  Buffalo,  N.Y. 

5.  "  The  Problem  of  Dependency  as  Influ- 
enced by  the  Chinese  in  America,"  W.  F. 
Southard,  San  Francisco. 

6.  "  What  Agencies  Conspire  to  Check 
Development  in  the  Minds  of  Children,"  J. 
Madison  Taylor,  Philadelphia. 

7.  "  How  to  Avoid  the  Dispensary  Abuse  ?  " 
Emma  B.  Culbertson,  Boston. 

8.  "  Contract  Medical  Work  and  Fees,'' 
Charles  P.  Knapp,  Wyoming,  Pa. 

9.  "  What  shall  we  do  with  our  Alcoholic 
Inebriate?  "  J.  W.  Grosvenor,  Buffalo,  N.Y. 

10.  "Life  Insurance  in  its  Relation  to  one 
of  the  Dependent  Classes,"  E.  O.  Bardweil, 
Emporium,  Pa. 

11.  "Some  Results  of  Competitive  Medical 
Charity,"  George   M.  Gould,  Philadelphia,   Pa. 

12.  "  Criminal  Anthropology,"  E.  V.  Stod- 
dard, Rochester,  N.Y. 

13.  Title  to  be  announced,  Leartus  Connor, 
Detroit,  Mich. 

14.  "The  Increase  of  Insanity,"  Gershom 
H.  Hill,  Independence,  la. 

15.  "A  Perfect  Consultation,"  L.  Duncan 
Bulkley,  New  York. 

16.  "An  Analysis  of  the  Reports  of  the 
Examinations  by  the  State  Boards  of  Medical 
Examiners,"  Perry  H.  Millard,  St.  Paul,  Minn. 

17.  "The  Limits  of  a  Physician's  Duly  to 
the  Dependent  Classes,"  James  W.  Walk, 
Philadelphia. 

18.  "The  Pxonomic  Aspect  of  American 
Charities,"  Bayard  Holmes,  Chicago. 

19.  "  Is  our  Financial  Relation  to  our 
Patients  and  Community  the  best  Possible," 
Woods  Hutchinson,  Des  Moines,  Iowa. 

Partial  promises  have  been  made  for  several 
additional  papers  ;  it  is  hoped  that  these  can 
be  definitely  mentioned  when  the  complete 
programme  is  issued. 

Members  preparing  papers  are  urged  to 
send  a  coj)y  of  the  paper,  or  an  abstract,  to  the 


Secretary  as  soon  as  possible,  in  order  that 
time  may  be  given  him  to  prepare  the  press- 
reports.  If  otliers  than  those  mentioned  con- 
template the  preparation  of  papers,  informa- 
tion should  at  once  be  sent  to  the  Secretary, 
as  the  completed  programme  must  be  issued 
early  in  April. 

EIGHTH  FRENCH  CONGRESS  OF  SUR- 
GERY. 

Contagion  ok  Cancer. — M.  Guelliot,  of 
Reims,  presented  a  communication  embodying 
the  results  of  an  inquiiy  as  to  the  contagious- 
ness of  cancer,  begun  in  1S91.  The  number 
of  cases  collected  by  him  in  which  cancer  ap- 
peared to  have  been  communicated  by  conta- 
gion was  forty.  In  the  author's  opinion,  his 
facts  show  ;  i.  That  cancerous  affections  are 
unequally  distributed  in  adjoining  districts,  and 
that  neither  heredity  nor  consanguinity  is  ade- 
quate to  account  for  this.  2.  That  there  are 
real  cancer-houses,  the  dwellers  in  which, though 
having  no  link  of  blood-relationship  between 
them,  are  successively  or  simultaneously  at- 
tacked by  malignant  tumors.  7.  That  cases  of 
cancer  attacking  two  persons  living  together 
are  relatively  frequent.  Of  100  such  cases, 
published  and  unpublished,  in  85  the  persons 
attacked  were  man  and  wife  ;  in  8  they  were 
medical  practitioners  who  had  been  specially 
engaged  in  the  treatment  of  cases  of  malignant 
disease.  According  to  the  author,  these  facts 
tend  to  show  that  cancer  is  transmitted,  dir- 
ectly or  indirectly,  and  that  it  runs  its  course  as 
an  infectious  disease  with  an  average  incuba- 
tion of  from  a  few  months  to  two  years,  a  pri- 
mary lesion,  then  generalization. 

Delore,  of  Lyons,  slated  that  cancer  seemed 
to  him  capable  of  being  transmitted  by  preg- 
nancy. Fifteen  years  ago,  at  the  Congress  of 
Blois,  he  had  brought  forward  a  case  in  point. 
— British  Medical  Journal,  October  20,1894. 

MIDLAND  MEDICAL  SOCIETY. 

Modern  Treatment  of  Pulmonary  Phthi- 
sis.— Dr.  C.  Theodore  Williams,  in  his  inau- 
gural address,  observed  that  the  various  spe- 
cific modes  of  treatment  of  phthisis  seem  to 
ignore  one  great  factor, — viz.,  the  resisting 
power  of  the  organism  to  disease.  A  glance  at 
the  history  of  the  treatment  of  phthisis  will 
show  ihat  whatever  success  has  been  attained 
has  been  due  to  strengthening  and  foitifying 
treatment,  whether  by  diet,  climate,  or  med- 
icines, and  not  by  so-called  sptcifir  treatment. 
Life  in  the  ])ure  air,  judicious  exercise,  a  light 
nourishing  dietary,  and  such  a'ds  as  cod  liver 
oil  and  tonics  have  effected  more  than  all  the 
bacillicide  treatmeni.s  put  together.  All  act  on 
the'  old  principle  of  helpnig  nature  to  help 
herself  against  her  foes  and  reducing  the  vuhier- 
ability  of  the  patient  to  attack. 


THE   CANADA   MEDICAL   RECORD. 


133 


The  problem  of  treatment  resolves  itself  prin- 
cipally into  means  to  increase  the  number  and 
activity  of  the  phagocytes,  thus  rendering  more 
probable  "he  destruction  of  the  tubercle  bacilli. 
To  promote  ihe  formation  of  lymph  and  of  blood 
rich  in  leucocytes,  experience  teaches  that  the 
surest  method  is  in  supplying  a  large  quantity 
of  oleaginous  food  under  conditions  which  pro- 
mete  its  absorption  and  assimilation.  Among 
this  class  cod  liver  oil  is  pre-eminent,  on  account 
of  its  penetrative  power  and  the  ease  with  which, 
with  pancreatic  juice,  it  forms  a  rich  emulsion 
cajjable  of  absorption.  It  is  probably  this  which 
has  caused  cod  liver  oil  to  do  so  much  good  in 
the  treatment  of  phthisis  ;and  when  we  reflect  on 
the  number  of  poor  phthisical  patients  in  the 
out-patient  departments  of  hospitals,  who  enjoy 
no  advantage  of  climate,  whose  surroundings  are 
the  reverse  of  sanitary,  whose  food  is  scanty,  and 
whose  trade  or  occupation  is  by  no  means  salu- 
brious, yet  who  hold  their  own  by  steadily 
persevering  for  months  and  years  with  cod  liver 
oil,  it  must  be  admitted  that  it  does  in  some 
subtle  way  supply  the  requisite  nourishment 
and  augment  (he  resi.«ting  force  of  the  system  ; 
the  diminution  of  the  usual  phthisical  symptoms 
and  the  rapid  gain  of  weight  and  strength  con- 
firm this.  With  regard  to  substitutes  for  cod 
liver  oil, — and  ihey  are  lesion, — he  has  given  a 
fair  trial  to  most  of  them,  and  has  not  yet  tound 
any  at  all  comparable;  but  the  combination  of 
the  oil  with  the  preparations  of  hypophosphiies, 
of  phosphorus,  and  arsenic  have  proved  very 
useful.  I'he  introduction  of  a  large  amount  of 
milk  into  the  dietary  is  to  be  aimed  at. 

The  most  important  factor  in  the  treatment, 
however,  is  pure  air,  and  on  its  thorough  appli- 
cation to  the  system  of  the  patient  most  success 
depends.  Sunshine  and  pure  air  are  the  best 
bacillicides.  A  leaf  might  with  advantage  be 
taken  by  English  physicians  out  of  the  book  of 
some  of  our  Continental  friends,  and  phthisical 
patients  be  fearlessly  trusted  to  a  little  more 
open-air  life  than  is  at  present  done. Undoubted- 
ly the  treacherous  climate  of  the  British  Isles, 
especially  in  winter  and  spring,  is  the  great  ex- 
cuse. At  most  English  health  stations  a  wet  or 
snowy  day  means  confinement  to  the  house, 
and  generally  to  the  fire-side,  for  the  whole 
twenty-four  hours,  the  usual  plea  being  the  great 
tendency  of  phthisical  patients  to  catch  cold 
and  contract  fresh  catarrh.  From  what 
goes  on  at  Davos,  St.  Moritz,  and  Falken- 
stein,  the  probability  of  catching  cold,  if  ordi- 
nary precautions  are  taken,  is  very  doubtful. 
There  phthisical  patients  almost  invariably  sleep 
with  open  windows  throughout  the  winter, 
when  the  thermometer  not  uncommonly  regis- 
ters 4  °  F.  (15.6°  C),  or  36°  F.  below  the 
freezing-point,care,  ofcourse,being  taken  to  heat 
the  rooms  with  stoves,  to  provide  plenty  of  blan- 
kets and  coverlets,  and  to  see  that  the  current  of 
exteri)al  air  is  not  directed  on  to  the  patient,  but 


that  it  first  ascends  to  the  ceiling.  The  universal 
testimony  of  medical  men  is  that  no  harm,  and 
much  good,  results  from  this  practice.  One  effect 
is  that  patients  accustom  themselves  to  live  at  a 
lower  temperature  without  noticing  it.  At 
Dav^os,  Leysin,  and  Fa^kenstein  there  are  cov- 
ered terraces,  or  long,  sheltered  corridors  open 
on  one  side  to  the  air  and  protected  from  wind, 
where  a  large  number  of  phthisical  patients  in 
various  stages  of  disease  recline  on  couches  for 
the  greater  part  of  the  day  in  all  weathers. 
These  galleries  are  deep  and  lofty,  generally 
facing  the  south,  sheltered  from  too  much  sun 
and  from  rain  and  snow  by  ciutains.  The 
patients  lie  on  well-cushioned  basket-work  or 
bamboo  couches  for  from  seven  to  ten  hours 
daily,  only  leaving  them  for  meals  or  exercise. 
In  the  winter  there  is  no  heating  apparatus,  and 
warmth  is  kept  up  by  fur  clothing  and  abun- 
dant covering.  At  Falkenstein,  on  the 
slopes  of  the  Taunus,  about  four  hundred 
and  sixty  feet  above  sea-level,  this  seems 
to  be  sufficient.  Besides  these  ten  aces  at 
Falkenstein  there  are  a  number  of  pavilions  in 
the  park  like  gardens,  some  holding  two  or 
four  invalids,  which  rotate  so  as  always  to  insure 
protection  from  wind  and  rain.  The  patients 
seem  quite  at  their  ease,  and  may  be  seen  read- 
ing, writing,  knitting,  and  playing  cards  and 
games  all  day.  They  can  keep  warm  even  at 
Davos.  Dr.  Williams  objected  to  a  continued 
recumb.Mit  position,  as  not  favoring  expec- 
toration, and  as  involving  a  want  of  exercise. 
For  the  cases  of  consolidation  or  of  excavation 
with  pyrexia,  exercise  is  undesirable,  and  a 
continuously-recumbent  position  the  best ;  but 
in  cases  of  limited  apical  lesions  and  limited 
cavities  without  fever,  it  is  desirable  for  the  pa- 
tient to  take  as  much  exercise  as  his  strength 
will  permit,  in  order  to  develop  and  extend  the 
healthy  portions  of  the  lung  and  to  increase  the 
muscular  power.  This,  however,  need  not  pre- 
vent the  patient  from  spending  the  resting  times 
of  the  day  in  the  recumbent  position  in  the  open 
air. 

The  speaker  then  made  some  remarks  on  the 
medical  treatment  of  the  disease  suggested  by 
thirty  years' experience.  Cougli  sho\ild  always 
be  treated  by  promoting  expectoration,  one  of 
the  best  forms  of  exi)ectorant  being  the  effer- 
vescing carboriate-of-ammonia  draught  night 
and  morning,  which  will  generally  clear  the 
bronchial  passages  for  several  hours.  If  there 
be  a  good  deal  of  fruitless  hacking  before  ex- 
pectoration, causing  annoyance  to  the  patient, 
the  addition  of  a  few  minims  of  dilute  hydro- 
cyanic acid  and  ^  drachm  (2  grammes)  of  syrup 
of  poppy  or  codeia  will  do  no  harm  and  consi- 
derably allay  the  reflex  irritation.  Where  the 
cavities  are  large,  deep,  or  basic,  and  conse- 
quently require  great  expiratory  effort  to  clear, 
combinations  of  sal  volatile  and  spirit  of  ether 
with  camphor-water    answer   admirably,  while 


134 


THE   CANADA    MEDICAL    RECORD. 


for  old  or  feeble  persons  champagne  will  often 
serve  the  same  purpose.  But  the  most  satis- 
factory way  to  reduce  the  cough  of  chronic 
phthisis  is  by  counter-irritation  to  the  chest- 
wall — best  by  blistering.  It  will  be  found  that 
relief  will  follow  in  proportion  to  the  amount  of 
serum  drawn  by  vesication,  and  fly-blisters  or 
acetum  cantha'ridis,  or  the  strong,  but  very 
efficient,  liquor  epispa-sticus,  answer  the  pur- 
pose. Night-sweats,  when  they  are  a  mere  flux 
from  the  vessels  or  lymphatics,  and  not  a  relief 
of  pyrexial  processes,  ought  to  be  checked,  and 
this  can  generally  be  done  by  arseniate  of  iron, 
^  grain  to  i;  grain  (o.oi  to  0.02  gramme)  at 
bedtime;  picrotoxin,  ^\,  grain  to  ,..\,  grain  (0.0013 
to  0.C026  gramme)  ;  or  nitrate  of  pilocarpine, 
^\  grain  (0.003  gramme)  ;  or  the  old-fashioned 
oxide  of  zinc  in  from  3-grain  to  5-grain  (0.2  to 
0.32  gramme)  doses,  which  generally  succeed 
and  do  no  harm.  Preparations  of  belladonna 
and  atropine,  though  they  are  effectual  con- 
trollers of  night-sweats,  are  less  satisfactory,  be- 
cause their  continuance  for  a  long  period  often 
induces  dryness  of  throat  andrnouih,  dilatation 
of  the  pupils,  and  disturbance  of  accommoda- 
tion. The  treatment  of  pyrexia  depends  very 
much  on  its  cause.  Where  it  accompanies 
tuberculization,  it  ]irobably  will  subside  of 
itself  when  the  tuberculous  process  becomes 
quiescent,  and  even  if  persistent  will  only 
prevail  in  the  afternoon.  An  effervescing 
saline,  with  a  few  drops  of  tincture  of  aconite  or 
a  few  grains  of  quinine,  is  all  that  is  then  wanted. 
But  pyrexia  accompanying  acute  excavation,  or 
acute  excavation  and  tuberculization,  is  very 
troublesome  and  sometimes  quite  intractable. 
Antipyretics  onlygive  temporary  relief,and often 
do  harm  by  depressing  the  patient's  constitu- 
tional powers  and  producing  collapse.  The 
great  objeciis  to  keep  the  patient  quiet  in  bed  or 
lying  on  a  couch,  and,  if  possible,  in  the  open 
air ;  to  feed  him  frequently  ;  and  to  supply  alco- 
hol to  repair  tissue-waste,  while  administering 
only  sufiicient  antipyretics  to  keep  the  temper- 
ature within  moderate  bounds.  Quinine  in 
small  doses  in  effervescence  before  or  during 
the  rise  of  temperature  will  often  sufiice,  or 
Henn's  well-known  pill  twice  a  day.  The 
diarrhoea  which  accompanies  tuberculous  ul- 
ceration may  be  checked  by  sulphate  of  copper 
and  opium  if  the  ulcerative  process  be  limited  in 
extent,  but  if  there  is  much  ulceration,  and  the 
ileum  and  large  intestine  are  invo  ved,  injec- 
tions are  best.  Tlic  enema  opii  of  the  Biitish 
Pharmacopceia  is  excellent,  but  some  most 
obstinate  cases  yield  to  large  injections  of  lin 
seed-tea,  which  has  a  most  soo.hing  influence 
on  the  irritable  ulcers. — /.<?//£v/,  November  3, 
1894. 

EIGHIH    IN  rEKN.X'llONAl.  foNtlRESS 
OFDE.MOGRAPHV  ANb  HVGIKXK. 

Dii'HiHERiA. — Professor  Loefller,  of  Greifs 
wald,  president  of  the  German  Committee  on 


Diphtheria,  slated  that  the  etiological  impor- 
tance of  the  diphtheria  bacillus  w^as  no  longer 
open  to  doubt.  Certain  other  afi"ections  of  the 
u])per  respiratory  tract  present  the  same  clinical 
picture  as  true  diphtheria,  and  may  have  the 
same  evolution  :  hence  statistics  of  an  epidemic 
of  diphtheria  and  the  character  of  such  an  epid- 
emic have  no  positive  value  unless  the  differen- 
tial diagnosis  has  been  made  by  bacteriological 
examination.  The  progress  of  ej)idemic  diph- 
tlieria  dei)ends  (i)  upon  the  number  and  virul- 
ence of  the  diphtheria  bacilli ;  (2)  upon  the  path- 
ogenic or  non -pathogenic  bacteria  associated 
with  the  diphtheria  bacillus,  increasing  its  viru- 
lence or  weakening  the  organism  by  their  pro- 
ducts; (3)  upon  individual  predisposition.  The 
diphtheria  bacillus  may  be  found  in  the  nose  or 
mouih  of  healthy  individuals  without  causing 
any  lesion  whatever,  producing  disease  only 
when  it  becomes  fixed  on  the  mucous  inem- 
brane, — a  condition  favored  by  previous  affec- 
tions. Atmospheric  changes,  especiallj'  damp- 
ness, seems  to  influence  the  appearance  of  diph- 
theria, which  is  most  frequently  transmitted  by 
direct  contact,  coughing,  kissing,  hands  which 
have  touched  the  fresh  secretion,  by  food,  or 
linen,  and  that  often  after  a  long  period  has 
elapsed. 

To  prevent  as  much  as  possible  the  spread 
of  the  bacilli  by  the  diseased  person,  local  anti- 
bacillar  treatment  should  be  instituted  from 
the  beginning,  whenever  possible.  The  most 
effective  means,  in  the  opinion  of  the  speaker, 
was  the  use   of  Behring's  antidiphtheric  serum. 

Dr.  Billings,  President  of  the  American  Com- 
inittee,  believed  that  the  name  '•  pseudodiph- 
theria  "  should  be  reserved  for  pseudomembran- 
ous inflammations  of  the  upper  respiratory 
passages,  produced  not  by  the  diphtheria  bacil- 
lus, but  by  the  streptococcus  and  other  bacteria. 
The  mortality  of  these  cases  is  low,  being  only 
1.7  per  cent,  in  private  practice  and  25  per 
cent,  in  hosjiitals. 

As  regards  the  disappearance  of  the  bacillus, 
of  752  cases  it  was  absent  in  325  three  days  after 
the  disappearance  of  the  exudate  ;  in  the  rest 
it  was  present  from  five  days  to  five  weeks  after- 
ward. •  In  14  families,  with  48  children,  where 
isolation  was  imperfect  or  not  carried  out  at  all, 
the  bacillus  was  observed  in  half  the  persons, 
40  per  cent,  of  whom  we.'-e  afterward  aftected 
with  diphtheria.  In  families  where  the  patients 
were  properly  isolated,  the  bacillus  was  found 
only  in  10  per  cent.  The  inhabitants  of  an 
infected  house  should  therefore  be  regarded  as 
suspects,  and,  if  not  isclaled,  at  least  frequently 
examined. 

Dr.  Edward  Scaton,  President  of  the  English 
Committee,  remarked  that  whereas  in  England, 
wiUiin  ih.e  last  ten  years,  infectious  diseases 
had  diminished  as  the  improvements  in  drain 
age  had  jjrogressed.  tliC  contrary  was  the  case 
with  di|ilitheria,  which  had  greatly  increased 
within  the  last  decade.     It  was  also  to  be  noted 


THE   CANADA    MEDICAL   RECORD, 


135 


that,  while  formerly  a  rural  disease,  it  had  now 
become  a  city  one,  tlie  schools  being  an  impor- 
tant factor  in  its  propagation.  The  investiga- 
tions of  the  Medical  Department  Board  show 
that  cliildren  from  3  to  12  years  are  most  fre- 
quently affected,  and  that  the  disease  is  often 
associated  in  the  beginning  with  affections  of 
the  upper  air-passages. 

M.  Filatow,  of  Moscow,  President  of  the 
Russian  Committee,  said  that,  though  tlie  con- 
tagiousness of  di|>litheria  was  undoubted,  there 
were  still  certain  epidemiological  facts  not 
explained  by  cont;)gion  alone.  Sporadic  cases, 
are  usually  seen  long  before  the  appearance  of 
.an  epidemic.  In  certain  countries,  epidemics 
of  diphlheria  are  observed  after  fatal  throat 
disease  in  hogs  and  other  animals.  The  epi- 
demics are  influenced  by  seasons  and  local 
conditions,  generally  increasing  in  autunm  and 
diminishing  in  summer. 

Mr.  M.  A.  Adams,  of  Maidstone,  England, 
concluded  that  damp,  close,  stagnant  condi- 
tions of  the  atmosphere  favored  the  increase  of 
diphtheria,  and  that  its  virulence  increased 
with  the  soil-air,  showing  that  it  depended 
upon  the  movements  of  the  subsoil-water. 

M.  Roux,  President  of  the  French  Commit- 
tee, gave  the  statistics  of  treaiment  ofdijihiheria 
with  antitoxin  at  the  Hopital  des  Enfants 
Malades,  Paris.  From  Febaiary  i  to  July  2.1, 
1894,  448  (hildren  were  thus  treated,  the 
moriality  being  109,  or  24.33  P^''  cent.  The 
average  mortality  from  1890  to  1894  was  51.71 
per  cent,  in  ;i  total  of  3971  children.  The 
benefit  from  the  antitoxin  treatment,  the  condi- 
tions being  tlie  same,  was  therefore  27.38  per 
cent.  Within  the  same  period  500  cases  of 
dii)htheria  were  entered  at  the  Hopital  Trous- 
seau, 316,  or  63.20  per  cent,  of  whom  died. 
Of  the  44S  children  treated  by  antitoxin,  128 
were  found,  by  bacteriological  examination,  not 
to  be  suffering  from  true  diphtheria;  20  other 
rases  were  in  a  dying  condition  when  brought  in. 
Of  the  300  cases  remaining,  there  were  78 
deaths,  or  26  per  cent.,  instead  of  50  percent., 
as  in  former  statistics,  before  the  use  of  anti- 
toxin. The  serum  used  was  takeii  from  immun- 
ized horses,  with  a  strength  of  between  50,00c 
and  100,000.  Of  this,  20  cubic  centimetres  5) 
drachms)  were  injected  under  the  skin  of  the 
thigh.  This  was  not  renewed  if  the  patient 
was  found  not  to  be  suffering  from  the  true 
diphtheria  ;  otherwise,  a  second  injection  was 
made  twenty-four  liours  later,  o.  10  or  0.20 
gramme  ( i  yj  to  3  minims)  being,  used.  This 
was  usually  sufficient  to  bring  about  recovery. 
It  the  temperature  remained  elevated,  however, 
a  third  injection  of  the  same  amount  was  made. 
The  average  weight  of  the  children  bemg  14 
kil  )grammes  (28  pounds),  the  amountof  serum 
injected. 'as  a  general  rule,  equaled  i-ioooth 
pait  of  their  body-weight,  and  in  exceptional 
cases  i-iooth  part.     Under  the  influence  of  the 


injections  the  general  condition  remained  excel- 
lent ;  the  false  membranes  ceased  to  form  with- 
in twenty-four  hours  after  the  first  treatment ; 
in  thirty-six  or  at  most  seventy-two  hours  they 
became  detached.  In  only  7  of  the  cases  did 
they  persist  longer.  The  temperature  frequent- 
ly fell  suddenly  after  the  first  injection  ;  if  it 
remained  elevated  in  the  cases  of  severe  angina, 
it  fell  only  after  the  second  or  third  injection 
in  lysis.  The  pulse  returned  to  normal  less 
rapidly  than  the  tem[)erature.  A  third  of  the 
cases  of  diplitheria,  according  to  statistics,  show 
albuminuria  ;  and  this  having  been  jjresent  in 
only  54  out  of  the  1  20  cases  treated  with  serum, 
it  seemed  evident  to  M.  Roux  that  the  remedy 
diminished  the  frequency  of  the  symptom. 

The  mortality  in  cases  of  croup  treated  with 
the  serum  was  also  much  less  than  with  other 
methods.  The  author  believes  it  possi  ble  to 
obtain  much  better  results  if  the  treatment  be 
instituted  earlier,  and  also  believes  that  tracheo- 
tomy will  become  more  and  more  rare,  being 
superseded  by  intubation,  combined  with  injec- 
tions of  serum. 

Dr.  Heubner,  of  Berlin,  read  a  paper  in  the 
name  of  Professor  Behring,  stating  that  the 
action  of  the  antitoxin  was  all  the  more  certain 
the  earlier  it  was  administered  in  any  given 
case.  The  injections  should  be  aseptic,  a  ster- 
ilized Koch  syringe  being  employed,  from  0.10 
to  0.12  gramme  (i  j4  to  i  4-5ths  minims)  being 
injected  at  a  time.  Massage  is  not  necessary 
afterward,  the  absorption  of  the  liquid  being 
more  ra^iid  and  the  pain  less  when  it  is  not 
practised. 

Dr.  Aronsop,  of  Berlin,  like  M.  Roux,  re- 
garded the  serum  of  the  horse  as  the  mosteftica- 
cious,  taken  from  animals  immunized  with  cul- 
tures through  which  a  current  of  oxygen  had 
been  passed.  This  serum  is  three  times 
stronger  than  that  used  by  Professor  Behring. 
F'rom  March  to  the  end  of  July  he  had  treated 
192  cases  of  true  diphtheria  by  means  of  the 
serum,  14  per  cent,  dying.  Of  these  children 
23  were  moribund  when  brought  into  hospital, 
leaving  169  cases  with  19  deaths,  or  a  mortality 
of  11.2  per  cent.  In  the  same  hospital  the 
mortality  Wiis,  in  1891,  32  5  per  cent,  in  203 
cases;  1892,  35.4  per  cent,  in  341  cases;  in 
1893,  41.7  per  cent,  in  426  cases;  and  from 
January  to  March,  1894,  41.8  per  cent.  The 
serum  treatment  was  also  employed  in  82  cases 
in  other  hospitals,  making  274  cases,  with  a 
mortality  of  15.3  per  cent. 

Dr.  Aron-on  also  made  use  of  the  serum  to 
render  immune  the  children  of  families  in  which 
diphtheria  had  occurred,  and,  of  130  such, 
only  2  were  affected  with  diphtheria,  and  that 
of  a  mild  form.  The  dose  used  was  i  cubic 
centimetre  (153^  minims), — La  Semaine  Medi- 
cale,  September  8,  1894. 


136 


THE   CANADA   MEDICAL   RECORD. 


gro^rcss    of    ^cicnce. 


TREATMENT     OF     SEVERE    ALBUMI- 
NURIA ASSOCIATED  WITH    PREG- 
NANCY. 

In  a  paper  read  at  the  last  meeting  of  tlie  Ob- 
stetrical Society,  Dr.  Herman  (^Med.  Press  and 
Circular)    concluded    a    valuable     series     of 
observations   on   albuminuria    associated  with 
pregnancy  and  labor.     Every  practitioner  who 
observes  his  cases  must  have  noticed  that  there 
are  at  least  two  main  groups  of  kidney  disease 
in  this  association.     Albuminuria  in  a  more  or 
less  marked  degree  is  a  very  common    compli- 
cation of  pregnancy,  but  in  a  large  proporlion 
(the    majority)  of  the  cases  it  does  not  lead  to 
any  of  the  graver  symptoms  lo  which  pregnant 
albuminuric    women   are    liable.     In    a  certain 
number   of  such  patients,  however,  not  only   is 
the  disease  acute  in  its  onset  and  violent  in  its 
manifestations,  but  we  get  the  dreaded  eclamptic 
convulsions  which  threaten  the  life  of  the  mother 
and    jeopardize    that    of  the    unborn    infant. 
The  risks  dependent  upon  the  renal  disease  are, 
then,  first,    the   life  of  the  mother  ;  secondly, 
that  of  the  foetus  ;   and,  lastly,  the  danger   of 
the  acute  phase  giving  place  to  a  chronic  form 
of  Bright's   disease    after  delivery.     The  main 
points    which    still  call   for  discussion  are  the 
means  of   distinguishing    between    the    cases 
which  are  likely  to  import  a  grave  sequel,  and 
the  best  method   of  obviating   the   danger  of 
usual    defects   and   renal  disease  as  a  sequel. 
Dr.  Herman  tells  us  that  the  acute  form  attacks 
mainly  women   wh.o  are  pregnant    for  the  first 
time,  and  he  points  out  that  when  the  albumen 
in  the  urine  consists   mostly  of  serum   albumen 
the  prognosis  is  grave.     It  is,  therefore,  neces- 
sary for  the  practitioner  to  accusio.n  himself  to 
testing    for   the   presence    of  paraglobulin    as 
compared   witli  serum   albumen.     One   of  the 
common  symptoms  associated  with  the  albumi- 
nuria  of  pregnant   women,  as  in  albuminuria 
from  other  causes,  is   failure  of  vision,    attri- 
butable to  the  presence  of  albuminuric  retinitis, 
and  possibly  subretinal  hemorrhages.     In  the 
graver  cases  this  may   go  on  to  complete  loss 
of  percei)tion  of  light.     Although  in  most  cases 
the  opacity  passes  off  more  or  less  when  delivery 
has  been    safely   accomplished,    this  is  by  no 
means   always    the   case,  and  I  lie  preservation 
or  i)rotcciion  of  sight  becomes  or  e  of  the  points 
to    which    treatment   must  be  directed.     Now, 
ihc  treatment  of  the    albuminuria   of  pregnant 
females  is  practically  confuied  lo  the   induction 
of  premature  labor.     As  soon  as  the  uterus  has 
been  emptied,  the  symptoms  usually  promptly 
subside  ;   indeed,  the  promptness  of  this  subsi- 
dence is  one  of  the    most    remarkable  features 
of  renal   disease    associated    with  pregnancy. 
The  speakers  in    the    discussion    that  followed 


accepted  this  conclusion,  and  did  not  hesitate 
to  recommend  that  the  uterus  should  be 
emptied  forthwith  in  all  really  serious  cases 
of  abuminuria associated  with  pregnancy.  The 
child  is  sacrificed,  it  is  true,  but  its  chances  of 
survival  in  the  presence  of  eclampsia,  or  even 
of  severe  albuminuria,  are  small  indeed,  so 
that  this  fact  cannot  and  ought  not  to  be 
allowed  to  weigh  in  the  balance,  especially  as 
the  mother  is  thereby  rescued  from  one  of  the 
most  terrible  complications  that  can  threaten 
the  pregnant  woman.  Then,  too,  in  the  cases 
presenting  indications  of  albuminuric  retinitis. 
These  are  always  severe  cases,  and  most  of  them 
die  if  left  unrelieved.  Moreover,  the  farther 
the  case  is  allowed  to  go  on  the  greater  is  the 
damage  done  to  the  delicate  structures  of  the 
eye  and  the  greater  are  the  risks  of  permanent 
imjiairment  of  vision.  This  is  a  serious  point 
well  worthy  consideration  ;  and  in  future,  obste- 
tricians will  be  well  advised  if  they  adopt  the 
suggestion  to  emjity  the  uterus  as  soon  as,  at 
latest,  ophthalmoscopic  examination  reveals 
the  familiar  and  easily  recognized  signs  of  albu- 
minuric retinitis.  There  remains  as  an  addi- 
tional reason  for  adopting  this  course  the  fact 
that,  even  in  women  who  either  do  not  have, 
or  who  survive,  the  fits,  the  kidneys  do  not 
always  recover  from  the  disturbance  to  which 
lliey  have  b.-en  subjected,  and  the  patient  not 
infrequently  remains  the  victim  of  chronic 
Blight's  disease.  On  these  grounds,  therefore, 
severe  albuminuria  ought  to  be  added  lo  the  list  of 
indications  for  the  induction  of  premature  labor, 
without  wailing  for  the  supervention  of  eclamp- 
tic convulsions  before  coming  to  a  decision. 
This  is  not  a  specialist's  question.  It  is  one  which 
any  practitioner  may  be  called  upon  to  con- 
sider at  any  moment,  and  it  is  to  be  hoped,  in 
t'-'e  best  interests  of  his  patient,  that  he  will 
henceforth  recognize  the  e.xireme  and  manifold 
gravity  of  the  risks  attending  the  continuance  of 
albuminuria  in  pregnant  women. —  Tlierapeiit-c 
Gazette. 

THE      ANTITOXIN    TREATMENT    OF 
DIPHTHERIA. 

Reports  from  various  parts  of  England 
show  that  in  a  very  large  proportion  of  cases 
complete  success  has  attended  the  use  of  the 
antitoxin  serum  in  the  treatment  of  diphtheria. 
Dr.  ^^■atkin  Hughes,  for  instance,  states  that 
during  the  present  severe  epidemic  of  diph- 
theria at  Barnham  liroom,  Norfolk,  he  has 
attended  40  cases ;  of  the  first  30  treated  by 
ordinary  methods,  10  died  ;  in  the  next  follow- 
ing 10  cases,  which  were  very  severe,  the 
Serum  treatment  was  used,  and  every  iiatient 
,recovered  after  a  single  injection.  To  obtain 
the  best  results,  experience  already  accumu- 
lated proves  that  the  treatment  must  be 
adopted  at  an  early  stage  of  the  disease ;  but 
at  the  ])resent   time,   unfortunately,    there    is 


THE  CANADA  MEDICAL  RECORD. 


137 


considerable  difficulty  in  obtaining  a  sufficient 
supply  of  the  serum.  In  France  its  prepara- 
tion on  a  large  scale  has  been  undertaken  by 
the  Pasteur  Institute,  and  it  is  hoped  that  in 
a  couple  of  months'  time  the  supply  will  be 
sufficient  for  the  needs  of  France.  The  Bri- 
tish Institute  of  Preventive  Medicine  expects 
shortly  to  be  in  a  position  to  supply  a  consid- 
erable quantity.  The  treatment,  however,  is 
rapidly  passing  out  of  the  experimental 
stage,  and  in  the  case  of  a  disease  so  murder- 
ous as  diphtheria,  which  produces  annually  so 
fearful  a  mortality,  especially  among  children, 
the  public  may  well  look  to  the  State  to  take 
steps  to  insure  a  constant  and  adequate  sup- 
ply of  the  remedy  at  a  reasonable  cost.  Pro- 
fessor Behring,  in  an  address  before  the  Ger- 
man Naturalists'  Society  of  Vienna,  stated 
that  in  Germany  and  Austria  alone  the  mor- 
tality from  diphtheria  might  be  estimated  to 
be  about  2,000,000  in  every  ten  years.  The 
serum  treatment  would  reduce  this  high  mor- 
tality, amounting  to  over  50  per  cent,  of  the 
persons  attacked,  to  10  per  cent.,  and,  if 
employed  in  the  early  stage,  to  5  per  cent. 
"  In  other  words,"  he  added,  "  about  1,500,- 
000  lives  may  be  saved  every  ten  years,  but  of 
course  the  serum  must  be  obtainable  in  large 
quantities.  This  is  not  now  the  case,  and  will 
not  be  the  case  until  the  State  takes  the  mat- 
ter in  hand  and  prepares  it  at  the  public  cost." 
The  mode  in  which  the  serum  is  obtained  at 
the  Pasteur  Institute  is  as  follows  :  The  an- 
imals which  are  to  furnish  the  antitoxic  serum 
are  rendered  immune  by  the  injection,  under 
certain  precautions,  of  the  toxin  of  diphtheria. 
This  toxin  is  formed  when  the  virulent  bacil- 
lus is  grown  in  broth,  and  in  practice  the  rate 
at  which  it  is  produced  is  increased  by  draw- 
ing a  current  of  air  through  the  culture  liquid. 
After  three  or  four  weeks  the  culture  is  suffi- 
ciently rich  in  toxin  to  be  used.  The  animals 
emplojed  are  horses  in  good  health,  and  prev- 
iously tested  by  the  injection  of  mallein  to 
prove  that  they  are  free  from  glanders.  The 
culture,  filtered  through  a  porcelain  filter, 
yields  a  clear  liquid,  with  which  the  horse  is 
inoculated  by  injection  under  the  skin.  Grad- 
ually, by  repeated  injections  over  a  period  of 
two  or  three  months,  the  horse  is  brought  into 
a  condition  in  which  its  serum  possesses  very 
high  antitoxic  properties.  The  animal  does 
not  suffer  in  health  at  all,  or  only  to  a  very 
slight  degree.  The  efficacy  of  its  serum  hav- 
ing been  ascertained  by  a  test  experiment  on 
a  guinea-pig,  the  animal  is  bled.  It  suffers 
little  from  this  operation,  and  it  is  possible,  if 
necessary,  to  bleed  it  again  in  two  or  three 
weeks,  but  it  is  advisable  in  the  interval  to 
strengthen  its  immunity  by  some  further  in- 
jections of  the  toxin.  The  animals  used  are 
cab-horses,  sound  in  constitution,  but  broken 
down  in  limb,  who  after  inoculation  live  a  life 


of  ease  and   luxury,    varied   by   a   periodical 

phlebotomy,  such  as  our  grandfathers  sub- 
mitted to  voluntarily  two  or  three  times  a 
year. — British  Medical  Journal ^  Oct.  6,  1894. 

Bchring's  Antitoxin. — Dr.  H.  U.  VValker, 
in  reporting  a  successful  case,  states,  with 
regard  to  Behring's  solution,  that  it  has  been 
proven  that  if  a  mixture  of  0,001  cubic  centi- 
metre (i-64th  grain),  with  the  same  amount  of 
poison,  is  subcutaneously  administered  to 
guinea-pigs,  not  only  are  no  symptoms  of  dis- 
ease caused,  but  also  no  local  symptoms  are 
observable,  especially  no  infiltration  at  the 
place  of  injection.  The  antitoxin  solution 
contains  2  to  2.5  per  cent,  egg-albumen  and  a 
further  admixture  of  0.4  per  cent,  trikresol  for 
preservation  purposes.  For  the  immuniza- 
tion of  adults  and  elder  children  i  cubic  centi- 
metre (1532  minims)  of  the  solution  is  in- 
jected subcutaneously  by  means  of  a  Pravaz 
syringe,  which  has  been  previously  sterilized 
by  alcohol  and  3-per-cent.  carbolic-acid  or  i- 
per-cent.  trikresol  solution.  For  young  child- 
ren up  to  2  years  the  dose  should  be  0.55 
cubic  centimetre  (8  minims).  The  above 
quantity  of  antitoxin  thus  administered  to 
persons  threatened  by  diphtheria  is  at  least 
ten  times  as  much  as  is  required  to  render 
them  immune.  The  immunity  from  diphtheria 
is  therefore  much  more  lasting. — Lancet,  Oct- 
ober 6,  1894. 

Maimer  of  Using  Antitoxin. — In  order  to 
arrive  at  any  satisfactory  conclusions,  it  is  all 
important  that  in  every  instance  where  anti- 
toxin is  used  there  should  be  a  bacteriological 
examination  of  the  throat.  It  is  also  impor- 
tant that  the  urine  of  the  patient  should  be 
examined  for  albumen  before  and  after  the  in- 
jection. The  dose  for  procuring  immunity, 
according  to  some  observers,  is  i  cubic  centi- 
metre {i^Vz  minims)  for  any  age  over  3  years, 
and  half  that  for  younger  children.  For  a 
cure  of  the  disease  during  the  first  2  or 
three  days,  under  2  years  of  age,  2  to  3  cubic 
centimetres  (31  to  46  minims);  from  2  to 
10  years,  5  cubic  centimetres  (r^  flui- 
drachms)  ;  over  10  years  of  age,  10  cubic 
centimetres  (2)^  fluidrachms).  After  the 
third  day,  in  a  severe  case,  twice  as  much  may 
be  used  with  positive  advantage.  If  the  dis- 
ease does  not  seem  to  be  ameliorated  by  the 
first  dose,  a  second  should  be  given  in  twelve 
hours.  The  question  of  dosage  is  one  that 
can  only  be  decided  by  a  more  extended  use 
of  this  agent.  In  the  account  of  the  cases 
treated  there  is  no  evidence  of  any  distressing 
or  annoying  symptoms  caused  by  the  injec- 
tion. One  advantage  of  this  treatment  is  that, 
after  the  injection,  into  the  back  or  abdomen, 
there  is  no  interference  with  the  patient;  no 
swabbing  of  the  throat ;  no  tearing  of  the  mu- 
cous membrane.  It  is  stated  that  even  in  the 
worst  cases  that  proceed  to    a  fatal  end  there 


138 


THE   CANADA   MEDICAL   RECORD. 


is  a  marked  amelioration  in  the  suffering ; 
that  the  dyspnoea  is  relieved  lo  a  certain  ex- 
tent. If  the  patient  dies,  his  death  is  compar- 
atively painless.  In  regard  to  the  kind  of 
syringe  tl^at  should  be  used,  it  must  be  said 
that  the  common  subcutaneous  syringe  is  not 
adapted  for  the  purpose,  because  it  cannot  be 
properly  sterilized  by  heat.  Koch's  syringe, 
which  consists  of  a  detachable  rubber  bulb,  a 
glass  barrel,  and  a  needle,  is  the  most  satisfac- 
factory  instrument  for  this  purpose.  The 
barrel  and  steel  needle  can  be  put  into  a  test- 
tube,  in  the  bottom  of  which  a  little  cotton  is 
placed,  the  tube  plugged  with  cotton,  and 
then  put  in  the  oven  of  a  cooking-stove  and 
kept  at  a  temperature  of  150°  C.  (302°  F.) 
for  half  an  hour  or  more,  or  until  the  coiton 
is  slightly  singed.  A  syringe  prepared  in  this 
way  will  remain  sterile  for  four  or  five  days. — 
Boston  Medical  and  Surgical  Journal^  Sept- 
ember 20,  1894. 

FOREIGN     BODY    IN    THE    GULLET  ; 

SUBHYOID  PHARYNGOTOMY ; 

RECOVERY. 

The  fort  ign  body  removed  by  E.  Schmiege- 
low,  of  Copenhagen,  consisted  of  a  plate  of 
India  rubber,  with  an  artificial  tooih,  4  centi- 
metres long  and  3  centimetres  broad,  which 
had  been  lodged  in  the  oesophagus  ol' a  peasant, 
aged  38  years,  for  four  weeks.  The  symptoms 
caused  were  sudden  fits  of  suffocation  during 
the  night,  the  India-rubber  plate  being  missed 
the  following  day.  There  was  considerable 
dysphagia. —  Ugeskrift  for  Lceger,  No.  14,  1894. 

CASTRATION  FOR  HYPERTROPHY  OF 
THE  PROSTATE. 

Ranim,  of  Christiania,  successfully  castrated 
two  patients  for  hypertrophy  of  the  prostate,  a 
third  patient  dying  from  pyremia  a  fortnight 
after  the  operation.  He  advances  the  following 
conclusions,  based  upon  his  own  and  other  in- 
vestigations :  (i)  the  prostate  belongs  to  the 
genital  organs  ;  (2)  it  retains  its  infantile  size 
in  cases  of  malformations  of  the  genital  organs 
and  in  castration  before  puberty  ;  (3)  it  shrinks 
in  adults  after  castration  ;  (4)  an  hyj)ertro- 
phied  prostate  shrinks  after  castration,  the 
diminution  of  volume  beginning  a  few  days 
after  the  castration  and  continuing  later  on  ; 
(5J  this  diminution  of  volume  is  of  therapuitic 
importance  in  cases  of  dysuria  caused  by 
mechanical  obstruction  from  an  hypertrophied 
prostate. — Norsk  Magazin  for  LKgcvidenska- 
ben,  No.  3,  1894. 

ELECTROLYTIC        TREATMENl'        OF 
TUMORS. 

J.  Raarsberg,  of  Copenhagen,  has  tried 
treatment  with  electrolytic  currents  of  very  con- 
siderable  strength  in  cases  of  different  tumors. 


In  cases  of  large,  subcutaneous,  cavernous 
angiomata  he  applied  two  or  more  needles 
connected  with  either  electrode  for  a  few 
minutes  in  different  parts  of  the  t-nnor,  using  a 
strength  of  50  to  135  milliamp6res.  the  patient 
being  under  chloroform.  The  advantages  of 
this  method  of  treatment  are  :  i)  that  it  is 
without  any  danger,  (2)  that  there  is  no  loss  of 
blood,  (3)  that  the  loss  of  substance  is  very 
slight,  and  (4)  that  one  or  a  few  seances  are 
sufficient.  Kaarsberg  also  tried  this  method 
in  cases  of  superficial  angioma,  the  results  being 
excellent,  especially  in  cases  of  large  subcu- 
taneous angioma  of  the  face  in  children.  The 
cosmetic  results,  however,  were  not  so  satis- 
factory. 

In  four  cases  of  fibrous  growths  of  the  naso- 
pharynx, the  author  increased  the  strength  of 
the  current  to  140-340  milliamperes.  generally 
using  two  steel  needles  (No.  10  Charriere),  of 
which  the  one  was  introduced  through  the  nose, 
the  other  through  the  mouth,  each  one  being 
connected  with  each  of  the  two  poles.  The 
patient  was  placed  under  chloroform,  and  the 
head  lovvered  so  as  to  prevent  blood  from  flow- 
ing down  into  the  trachea,  the  haemorrhage 
often  being  considerable.  During  the  after- 
treatment  it  was  sometimes  necessary  to  use 
tiie  galvano  cautery  or  scissors  to  remove  frag- 
ments which  could  not  be  reached  by  means  of 
the  needles.  In  all  cases  complete  recovery 
occurred  after  one  or,  at  the  most,  two  seances, 
and  there  has  been  no  recurrence. 

In  two  cases  of  inoperable  cancer  of  the 
breast,  death  took  place  from  recurrence,  but 
the  examination  showed  that  the  tissue  of  the 
axilla  treated  by  electrolysis  was  transformed 
into  firm  connective  tissue,  free  from  all  traces 
of  cancer  except  around  the  sheaths  of  the 
nerves,  and  the  author  is  inclined  to  think  that 
recovery  would  have  been  permanent  if  the 
electrolytic  treatment  had  been  instituted  before 
the  growth  had  invaded  the  nerves-  In  a  third 
case  of  inoperable  cancer  of  the  breast  recur- 
rence has  not  taken  place  for  three  years.  In 
the  three  cases  mentioned,  the  strength  of  the 
current  applied  was  enormous,  once  reaching 
680  milliamperes.  Before  commencing  the 
treatment  with  currents  of  such  great  strength, 
the  author  made  exi)eriments  on  rats  and  dog>-. 
The  highest  strength  which  could  be  obtained 
was  760  milliamperes  ;  this  current  a  large  dog 
was  able  to  stand  witliout  showing  any  ill 
effects. — Hospitals- Tidende,  Nos.  6-8,   1894. 

ACETANILIDE  FOR  VOMITING. 

Among  the  many  uses  to  wiiich  acetanilide 
has  been  put,  other  than  that  of  an  analgesic, 
we  desire  to  call  attention  to  its  employment 
'in  the  treatment  of  obstinate  vomiting,  par- 
ticularly when  that  vomiting  seems  to  be  due 
chiefly  to  nervous  disturbance  or  marked  gas- 
tric irritability.     In  the  treatment  of  the  vomit- 


THE   CANADA   MEDICAL    RECORD. 


139 


ing  following  operations,  acetaiiilide  is  particii-    | 
larly   useful,  and  the  administration  of  2  grains    j 
every  hour  until  6  grains   are  taken  will  often    j 
prevent  this    unpleasant   sequel  of  operative    | 
interference.       We  have   used  acetanilide  for 
this  purpose  a  number  of  times  with  very  satis-    ' 
factory   results,   our  attention  having  first  been    j 
called  to  it  by  Dr.  Brown,  of  S:oux  Falls,  S.D., 
who  told   us   that  it  was  his  custom  in  country    j 
practice    to    leave    acetanilide   witli  the  nurse 
after  the  operation,  with  instructions  to  admin- 
ister the  drug   should   vomiting  after  recovery 
from  the  ana^bthelic  be  an  annoying  symptom,    j 

Wiiether  it  is  of  value  in  the  treatment  of  the 
vomiting  of  pregnancy  we  do  not  know,  but  .we  j 
would  suggest  its  further  trial.  Probably  the 
best  way  to  administer  it  is  to  place  the  pow- 
dered drug  in  a  little  brandy,  and  then  to  add 
to  a  spoon  some  ice  which  has  been  finely  pul- 
verized. In  this  way  we  not  only  get  the  stim- 
ulating and  antiemetic  powers  of  the  brandy, 
but  we  aid  in  the  soluiion  and  therefore  in  the 
rapid  absorption  of  the  acetanilide.  It  is  i:)os- 
sible  that  the  drug  exercises  its  anti-emetic  effects 
chiefly  by  its  influence  upon  the  stomach  itself, 
but  we  are  incHned  to  think  that  the  benefit  is 
derived  not  only  from  this,  but  also  from  its 
influence  on  the  nervous  system  after  it  is 
absorbed. — Therapeutic  Gazette. 

THE     VALUE    OF    CHLOROFORM    IN 
INTERNAL  MEDICINE. 

We  are  so  apt  to  regird  chloroform  as  a  pure 
anaesthetic  when  taken  by  inhalation,  that  many 
of  us  are  wont  to  overlook  its  value  as  an  in- 
ternal medicament,  and,  as  a  result  of  this 
oversight,  lose  a  valuable  aid  to  treatment  in 
many  affections,  some  of  which  are  apt  to 
obstinately  resist  the  ordinary  remedial  mea- 
sures. One  of  the  most  important  applications 
of  chloroform  is  its  internal  use  for  the  relief 
of  pain  eiiher  in  the  chest  or  abdomen,  pain 
in  the  latter  region  yielding  naturally  more 
readily  to  its  influence.  Particularly  is  this  the 
case  where  the  pain  is  of  a  griping  character-, 
either  due  to  irritability  of  unstriped  muscular 
tissue  in  the  wall  of  the  intestine  or  to  the  pres- 
ence of  irritating  foods  or  large  quantities  of 
flatus.  Under  such  circumstances  20  to  40 
drops  of  the  spirit  of  chloroform  added  to  two 
tablespoonfuls  of  water,  and  perhaps  aided  by 
10  to  20  drops  of  the  spirit  of  camphor,  is  one  of 
the  very  best  prescriptions  that  we  can  give. 
Further  than  this,  those  of  us  who  believe  in 
the  value  of  antiseptic  medication  will  recognize 
the  fact  that  chloroform,  under  the  circum- 
stances which  we  have  named,  not  only  relieves 
the  pain,  but  acts  as  one  of  the  most  powerful 
antiseptics  which  can  be  taken  internally  vvith 
moderate  impunity.  It  is  a  well-recognized 
fact  in  therapeutics  that  many  vo'atile  sub- 
stances   seem    to    exercise    very    considerable 


power  in  checking  all  forms  of  watery  diarrhoea, 
and    where  pain  in  the  abdomen  is  associated 
wiili  liquid  movements,  chloroform  possesses  a 
third  scope  for  usefulness.     Not  only  is  it  of 
value  in   the    forms  of  pain  which  are  due  to 
direct  irritation  or  inflammation  in  the  abdomen, 
bat  it  is  also  useful  in  those  pains  which  aie  due 
to  nervous  disturbance,  such,  for  example,  as  in 
ordinary  neuralgia  of  the  stomach  or  true  gas- 
tralgia.      In  obstinate  vomiting,  2  to  5  drops  of 
puie  chloroform  in   a  little  water,  taken  in  tea- 
spoonful  doses,  will  often  act  advantageously, 
and  when  the  vomiting  is  due  to  the  ingestion  of 
bad  food,  particularly  food  which  has  undergone 
some  decomposition  process,  it  is  especially  in- 
dicated.    In  the  vomiting  of  pregnancy,  with 
some  practitioners,  it   is  held  to   be    the   best 
remedy.     Another  very  valuable  application  of 
chloroform  is  its  employment  externally  in  lini- 
ments in  cases  of  muscular  rheumatism  for  stiff- 
ness of  the  muscles  due  to  strain  or  excessive 
exercise.       Possessing,    as    it   does,    not   only 
counter-irritant,   but  anaesthetic  effects,  its  em- 
ployment in  this  manner  is  most  advantageous. 
Another  use  to  which  it  is  too  rarely  pat  is  for 
the    production    of  counter-irritation    varying 
from  slight  reddening   to  actual  blistering  of 
the  skin.     Slight  reddening  is  rapidly  produced 
by  applying  a  cloth    saturated  with  chloroform 
to  some  portion  of  the  skin  so  remote  from  the 
respiratory  apparatus  as  to  avoid  inhalation  in 
any  large  quantity,  and  the    blisters   may  be 
formed  by  placing  chlorofonii  on  the  skin  under 
a  watch-glass,   so   that    too   rapid  evaporation 
will  not  take  place.     For  those  who  are  unable 
to    take   opium    in   any   combination  for    the 
relief  of  pain  in  any  part  of  the  body,  a  pre- 
scription composed    of  30  drops  of  spirit  of 
chloroform  and  10  minims  of  the  fluid  extract  of 
a  good  cannabis  indica  is  a  valuable  prescrip- 
tion.— Therapeutic  Gazette. 

FISTULA  IN  ANO. 

Dr.  John  E.  Piatt  has  analyzed  76  cases  of 
this  affection  treated  by  .him,  and  concludes 
that  fistula  is  very  much  more  common  in  men 
t'lan  women,  only  8  of  the  76  cases  being 
females.  The  great  majority  occurred  between 
the  ages  of  20  and  50  years,  only  4  being  under 
20  years.  There  were  definite  signs  of  phthisis 
in  21  (28.7  per  cent,),  and  a  family  history  of 
consumption  in  5  or  6  others  who  themselves 
showed  no  sign  of  the  disease.  As  pointed  out 
by  AUingham,  phthisical  fistulce  usually  present 
certain  well-marked  characteristics.  The  inter- 
nal opening  is  large  and  open,  being  often 
large  enough  to  admit  the  tip  of  the  finger. 
The  external  opening  is  also  large  and  irre- 
gular, its  edges  livid  and  flapping,  and  the 
surrounding  skin  undermined.  The  discharge 
is  thin,  watery,  and  curdy  ;  the  sphincter 
muscles  are   weak,  the  ischial  tuberosities  are 


I40 


THE   CANADA   MEDICAL   RECORD. 


prominent  from  wasting  of  the  fat  in  the  ischio- 
rectal fossae,  and  the  hairs  of  the  part  are  long, 
soft,  and  silky. 

He  calls  attention  to  the  necessity  of  care- 
fully exploring  the  fistula  and  laying  it  open. 
He  met  with  many  cases  which  would  not  heal 
because  this  measure  had  l)een  neglected.  If 
the  track  be  lined  with  indolent  granulations 
or  low  vitality,  these  sh  uild  be  scraped  away 
with  a  Volkmann  spoon.  This  is  especially 
necessary  in  phthisical  subjects.  The  cases 
should  be  carefully  watched  after  operation, 
until  the  wound  is  perfectly  healed.  Phthisical 
fistulas  require  a  longer  time,  after  operation, 
for  healing  than  non-phthisical  fistulas,  the 
average  time  required  being  nine  and  seven 
weeks  respectively.  The  bad  results  said  to 
occur  after  operation  in  phthisis  are  almost,  if 
not  quite,  non-existent.  Operation  can  be 
performed  with  safety  and  with  good  results  in 
a  larger  number  of  cases  than  is  usually  sup- 
posed. "I  he  activity  of  the  lung  disease  should 
determine  the  question  of  operating.  If  this 
is  great,  operation  should  not  be  undertaken 
unless  the  fistula  is  the  cause  of  much  pain  and 
distress.  If  the  phthisis  is  comparatively 
quiescent,  the  results  of  operating  may  be 
good.  Cavitation  of  the  lungs  is  not  an  abso- 
lute contra-indication  to  surgical  treatment  of 
the  fistula,  which  is  often  followed  by  improve- 
ment in  the  general  health. — Medical  Chro- 
nicle^ June,  1894. 

ON    thp:    use    of   antipyrin    in 

LARGE  DOSES. 

The  writer  advocates  the  use  of  very  large 
doses  of  antipyrin  in  certain  neurotic  cases. 
He  says  that  personally  he  has  hardly  any 
experience  of  its  deleterious  effects — at  least  of 
a  serious  nature — when  employed  with  due 
precautions.  He  details  the  case  of  a  boy, 
aged  nine  years,  who  had  suffered  for  the  pre- 
vious two  and  a  half  years  from  severe  fits  of 
hystero-epileptic  character,  sometimes  as  many 
as  30  or  40  attacks  occurring  in  a  day.  The 
treatment  consisted  of  rest  in  bed,  regulation 
of  the  bowelSj  and  the  exhibition  of  antipyrin 
»'in  gradually-increasing  doses,  commencing 
with  five  grains,  thrice  daily.  In  three  weeks 
he  was  taking  twenty-five  grains  three  times  a 
day,  with  complete  cessation  of  the  attacks. 
The  dose  was  then  slightly  lowered.  The  lad 
was  dismissed  from  the  hospital  in  two  montlis 
as  quite  well,  and  it  was  reported  later  that 
there  had  been  no  recurrence  of  the  attacks. 
In  another  case  a  lad  of  thirteen  years,  suffer- 
ing from  choreic  movements  of  the  right  side, 
received  under  gradually  increasing  doses  as 
much  as  50  grains  thrice  daily.  He  left  the 
hospital  in  six  weeks  quite  well.  In  another 
violent  case  improvement  was  very  rapid 
under  similar  treatment.     Dr.  Anderson  sums 


up  his  experience  in  the  following  aphorisms : 
I.  Antipyrin  is  not  the  dangerous  drug  that 
some  observers  have  led  us  to  suppose.  2.  It 
may  be  given  with  safety  in  large  doses,  but 
the  initial  dose  must  be  small,  and  it  must  be 
slowly  and  cautiously  increased  under  careful 
supervision.  3.  In  large  doses  it  often  yields 
surprisingly  good  results,  and  in  chorea  it  is  the 
only  medicine  from  which  cures  may  confi- 
dently be  expected. — Brit.  Med.  Jonr. 

POTASSIUM  MTRATE  I  ^  THE  TREAT- 
MENT OF  PHLEGMASIA  ALlJA 
DOLFNS. 

Hovnanian  describes  his  use  of  nitrate  of 
potassium  in  this  affection  in  the  Medical 
N'eivs  of  July  28,  1894. 

It  has  fallen  to  his  lot  to  treat  three  well- 
marked  cases  of  phlegm.. sia  alba  dolens  with 
potassium  nitrate  with  such  gratifying  results 
as  to  seem  to  justify  publication. 

Mrs.  H.,  twenty-tiiree  years  old,  was  deliver- 
ed of  her  first  child  by  her  family  pliysician 
with  instruments,  and  sustained  extensive  lacer- 
ations of  the  cervix  uteri  and  perineum,  which 
at  the  time  were  not  repaired,  but  were  left  for 
a  secondary  operation.  Twelve  days  after  de- 
livery she  complained  of  pain  and  heaviness  in 
the  left  leg,  and  within  three  days  there  devel- 
oped well-marked  phlegmasia.  On  the  fourth 
day  of  this  complication  the  writer  saw  the  pa- 
tient in  great  agony,  with  a  temperature  of 
105.2°  F.,  a  pulse  of  130,  and  respirations  25. 
The  limb  was  so  turgid  and  swollen  that  there 
seemed  to  be  great  danger  of  gangrene  or 
rupture.  The  woman  was  at  once  given  mor- 
phine sulphate  (^i  grain)  hypodermically,  and 
her  limb  was  wrapped  with  cotton  and  placed 
on  a  feather  pillow  at  a  very  obtuse  angle. 
Hovnanian  then  prescribed  a  solution  of  potas- 
sium nitrate  in  water,  representing  5  grain 
doses,  to  be  given  every  hour  until  his  return. 
Seven  hours  later  he  found  his  patient  in  bet- 
ter condition,  with  a  temperatare  of  103''  F.,  a 
pulse  of  112,  and  respirations  22,  and  with  less 
pain  and  discomfort.  The  swelling  seemed  to 
be  less  tense  and  the  veins  less  engorged.  The 
nitrate  was  continued  as  before  until  morning, 
when  he  found  her  in  yet  better  con  hiion.  She 
had  slept  well  during  the  night,  although  she 
had  been  wakened  regularly  for  her  medicine. 
Her  temperature  was  ico"'  F.,  her  pulse  95, 
her  respirations  20.  The  swelling  was  reduced 
to  less  than  half,  and  the  returning  circulation 
was  fairly  well  established.  There  was  no  pain 
whatever  and  but  slight  tenderness  on  pressure. 
The  medicine  was  continued  every  two  hours 
during  the  day,  until  the  author  saw  her  late  in 
the  evening,  with  a  temperature  of  99**  F.,  a 
pulse  of  90,  and  respirations  18.  The  swelling 
liad  almost  entirely  gone,  and  everything  was 
in  good  condition.      The  nitrate  was  continued 


THE  CANADA  MEDICAL  RECORD. 


141 


for  two  days  in  smaller  doses  and  at  longer  in- 
tervals, and  then  discontinued. 

Two  other  equally  typical  cases  are  also  re- 
corded in  this  paper. 

PHYSIOLOCilCAL  REST  IN  THE  TREAT- 
MENT OF  PROLAPSE    OF  THE 
RECTUM. 

Bryant  {^Mathe.w'' s  Medical  Quarterly,  vol. 
i.,  No.  4)  reports  the  case  of  a  man  operated 
on  seven  limes  for  the  relief  of  extensive  pro- 
lapse of  the  anus,  with  its  attendant  distressing 
symptoms.  Until  the  last  operation,  surgical 
intervention  had  been  of  httle  benefit.  Bryant, 
to  whom  he  finally  came,  made  an  artificial 
anus  in  the  kft  groin,  putting  ihe  patient  to  bed 
for  two  weeks,  meaning  to  proceed  to  further 
treatment.  But  this  operation  was  followed  by 
so  much  relief  and  by  such  a  marked  diminu- 
tion in  the  pressure  that  he  was  content  to 
adopt  no  further  ])rocedure.  He  submits  the 
following  propositions  as  a  conclusion  to  his 
paper : 

That  the  proper  performance  of  the  physio- 
logical functions  of  the  rectum  contributes 
greatly  to  ihe  advancement  of  rectal  disease 
and  to  the  sufferings  of  the  afflicted. 

That  the  complete  vicarious  discharge  of  the 
faeces  through  an  artificial  anus  located  in  the 
sigmoid  flexure  reduces  the  physiological  de- 
mands on  each  structure  of  the  rectum  to  a 
minimum. 

That  the  lessening  of  the  physiological  re- 
quirements is  commonly  in  direct  proportion 
to  the  diminution  of  the  faecal  flow  through  the 
rectum. 

That  the  cessation  or  lessening  of  the  ftecal 
discharge  per  lectum  exercises  a  palliative  and 
curative  influence  on  diseases  of  the  rectum. 

That  in  certain  cases  of  obstinate  rectal  pro- 
lapse the  formation  of  a  vicarious  channel  for 
faecal  discharge  is  justifiable,  both  as  a  pallia- 
tive and  curative  measure. 

That  the  preliminary  establishment  of  such 
a  channel  for  the  purposes  of  cleanliness  and 
the  prevention  of  infection  is  justifiable  in  many 
grave  operations  for  the  prolapse  of  the  rec- 
tum. 

That  the  dangers  attendant  on  the  formation 
of  an  inguinal  anus  are  much  less  than  those 
invited  by  the  contact  of  faecal  discharges  with 
large  operative  surfaces  of  the  rectum. 

That  the  case  just  presented  has  been,  with- 
out special  risk,  greatly  benefited,  and  may  be 
finally  cured,  through  the  agency  of  an  artifi- 
cial anus. 

That  when  cure  takes  place,  great  care  must 
be  exercised  thereafter,  otherwise  the  prolapse 
will  return. 

DIAGNOSIS  OF  APPENDICITIS  BY 
PALPAITON. 

Dr.  George  M.  Edebohls  strongly  advocates 
this   method  of  diagnosing  disease  of  the  ver- 


miform appendix.  He  uses  the  right  hand  only, 
externally,  for  palj)ation,  placing  two,  three  or 
four  fingers,  palmar  surface  downward,  almost 
flatly  upon  the  abdomen,  at  or  near  the  um- 
bilicus. While  he  draws  the  fingers  over  the 
abdomen,  in  a  straight  line  from  the  umbilicus 
to  the  anterior  superior  spine  of  the  right  ilium, 
he  notices  carefully  the  character  of  the  various 
structures  as  they  come  beneath  and  escape  fi  om 
the  fingers  passing  over  them.  In  doing  this 
the  pressure  exerted  must  be  deep,  enough  to 
recognize  distinctly  the  resistant  surfaces  of 
the  posterior  abdominal  wall  and  of  the  pelvic 
brim.  Pressure  less  than  this  will  fail  of  its 
object.  The  appendix  is  recognized,  on  exert- 
ing this  necessary  pressure,  as  a  more  or  less 
flati'^ned,  ribbon-like  structure,  when  normal,  or 
as  a  more  or  less  rounded  and  firm  organ,  of 
varying  diameter,  when  its  walls  have  been 
thickened  by  past  or  present  inflammation. 
When  it  is  the  seat  of  inflammatory  changes,  it 
is  always  more  or  less  sensitive  on  pressure  \ 
normally  it  is  not  so.  A  good  guide  is  formed 
by  the  right  common  and  external  iliac  arteries, 
the  pulsation  of  which  can  easily  be  felt.  The 
appendix  is  generally  found  almost  immediately 
outside  of  them.  Its  origin  is  practically  always 
at  McBurney's  point,  and  at  its  base  it  is  sep- 
arated from  the  iliac  arteries  by  a  space  of  one- 
half  to  one  inch,  while  lower  down  in  its  course 
it  usually  crosses  very  obliquely  the  line  of  the 
arteries.  Starting  from  McBurney's  point,  any 
deviation  from  its  usual  course  can  easily  be 
recognized. 

The  author  gives  one  broad  rule  as  regards 
operative  interference  in  appendicitis  :  not  to 
operate  in  chronic  cases  unless  you  can  feel  the 
diseased  appendix,  nor  in  acute  cases  unless  by 
palpation  3'ou  can  recognize  either  the  dis- 
eased appendix  or  the  presence  of  a  tumor. 
Anaesthesia,  in  some  exceptional  cases,  may  be 
necessary  to  decide  the  question. — American 
Journal  of  the   Medical   Sciences,  May,   1894. 

THE    DANGER    OF    ANESTHETIZING 
DIABETICS. 

BdiXtv  {Dent.  Med.  Woch.,  1894)  calls  atten- 
tion to  the  danger  of  narcotizing  diabetics.  He 
has  reported  three  of  his  own  cases  and  nine 
collected  from  medical  literature.  Even  in 
slight  cases  of  diabetics  the  patients  became 
comatose  and  died.  Coma  did  not  develop 
until  after  the  chloroform  narcosis  had  passed 
off,  in  twenty-four  to  forty-eight  hours.  The 
patients  then  became  indifferent,  stupid,  and 
confused.  Finally,  lost  consciousness,  urine 
and  fseces  were  passid  involuntarily,  and  they 
perished  in  coma.  This  communication  is 
important,  since  it  shows  that  the  administra- 
tion of  chloroform  is  dangerous  even  when 
there  is  a  slight  degree  of  diabetes,  it  being 
impossible  to  predict  whether  or  not  coma  will 
develop. 


142 


THE    CANADA   MEDICAL   RECORD. 


THE  CANADA  MEDICAL  RECORD 


J'uBLisHED  Monthly. 


Sii'iscriyli'^n  /'rice,  $1.00  per  annum  in  alrance.     Sinr/'e 
Co/lies,  10  els, 

EDITORS : 
A.  LAPTHORNSMITH,  B  A.,M.D.,  M.RC.S.,  Eng.,  F.O-S. 

London. 
F.  WAYLAND  CAMPBELL,  M.A.,  M.D.,  L.RCP  ,  London 

ASSISTANT  EDITOR 
ROLLO  CAMPBELL.  CM.,   M-D. 

Alake  all  Checiiu-s  or  P.O.  Money  Oi-d.-rs  for  subscription  or 
H.lvfrtisiiig  payable  to  JOHN  LOVELL  &  SON,  23  St,  Nicho- 
l.is  Street,  Montreal,  to  whom  all  business  communications 
b1k)uU1  be  addressed. 

All  letters  on  professional  subjects,  books  for  review  and 
exchanges  should  be  addressed  to  the  Editor,  Dr.  Lapthorn 
Smith.  248  Bishop  Street. 

Writers  of  original  communications  desiring  reprints  can 
have  tliem  at  a  trifling  cost,  by  notifyhig  JOHN  LOVELL  & 
SON,  immediately  on  the  acceptance  of  their  article  by  the 
Editor. 


MONTREAL,  MARCH,  1895. 


THE      SAMARITAN      HOSPITAL     FOR 
WOMEN,  MONTREAL. 

A  new  hospital  for  women,  with  the  above 
name,  was  open-d  by  Her  Excellency  the 
Countess  of  Aberdeen,  wife  of  the  Governor 
General  of   Canada,  on  the   lyih  of  January, 

1895. 

It  is  non  sectarian,  and  supported   entirely 

by     voluntary   contributions,  of   which     latter 

enough  were  handed  in  during  the  first  month 

to  carry  on  the  work  during  a  whole  year.     It 

is    the    only    special  hospital  for    diseases  ot 

women    in  Montreal,  and  will  be  moulded  on 

the  pattern  of  the  celebrated  New  York  State 

Women's  Hosi)ital    in  New  York   city.     It  is 

managed  by  a  board  of  thirty  of  the  principal 

ladies  of  the  city,  assisted  by  an  advisory  board 

of  three    laymen    and    three  physicians.     The 

staff    consists    of    Sir    James    Grant,    M.D., 

K.C.M.G.,    consulting     physician;    Wm.     H. 

Kingston,   M.D.,  LL.I).,  consulting  surgeon; 

A.    Lapthorn    Smith,    B.A.,    M.I).,    M.R.C.S. 

England,  surgeonin-chief;   H.    Lionel   Reddy, 

CM.,   M.D.,    surgeon;  S.    E.    Wilson,    CM., 

M.D.,  assistant   surgeon    and   registrar  ;    Dr. 

Sylvester,  assistant  surgeon,  and  Dr.  Letellier 

dc  St.  Just,  assistant  surgeon.     An  anaesthetist 

and  a  pathologist    will    be  appointed  shorty. 

The  outdoor   service   is    attended   to    by    the 

assistant  surgeons  from  4  to  5  p.m.  every  day, 

at  which    hour  the  surgeon-in-chief  makes  his 

daily    visit,    and  the    most    urgent    cases  aic 

admitted.     The    hospital  is  absolutely   free  to 


women  who  are  poor  and  sick,  and  who  are 
residents  of  the  city.  Patients  from  outside 
the  city  will  be  admitted  on  payment  of  a  nom- 
inal charge.  The  operation  days  are  Tues- 
days and  Fridays  at  10,30  a.m.,  when  phy- 
sicians who  have  not  been  attending  infectious 
diseases  will  receive  a  hearty  welcome.  The 
hospital  is  situated  in  the  choicest  and  health- 
iest part  of  the  city,  1000  Dorchester  street, 
near  Mackay  street,  and  may  be  reached  by 
the  St.  Catherine  and  St.  Antoine  St.  cars, 
which  each  pass  within  one  block  of  the  door. 

OVERCROWDED     PROFESSIONS. 

We  have  more  than  once  called  attention  to 
the  overcrowded  condition  of  the  Medical  Pro- 
fession in  England,  and  we  have  expressed  the 
hope  that  a  similar  s'ate  of  affairs  will  never  be 
seen  in    Canada.     From   the   letter  which  we 
copy  hereunder  from  a  recent  issue  of  the  Afai/ 
and  Empire  of  Toronto, it  appears  that  the  pro- 
fession in  Canada  is  rapidly  becoming  filled  to 
overflowing.      Tbe  Medical  Colleges  of  course 
have  no  interest    in  curtailing  the   number  of 
students,  so  the    profession  must  look  to    the 
Medical  Council  of  each  province  to  either  raise 
the  license  fees  or  raise  the  standard  of  the  en- 
trance examinations  in  order  to  keep  down  the 
number  of  practitioners    to    i  per  1000  of  in- 
habitants.   Neither  should  we  adinit  graduates 
from    other    countries   who  have  not  complied 
with  the  same  requirements  as  are  demanded 
from    our  own  graduates.     The   simplest   and 
best   standard  for   admission   to    study  is    the 
B.A.  degree  of  a  recognized  University,  simply 
because  it  is  a  guarantee  that  its  possessor  has 
gone  through  a  long  i:ourse  of  intellectual  train- 
ing, which  is  of  great  advantage  to  those  who 
are  to  be  the  Medic  U  men  of  the  future. 

"  'Sir, — .\  very  sjrious  problem  has  arisen  of 
late  years — What  are  the  professions  coming 
to?  Every  farmer  wants  his  sons  to  embark 
upon  the  troubled  sea  of  professional  life,  and 
cheap  education,  together  wi.h  the  glittering 
clap-trap  literature  with  which  this  province  is 
flooded  by  the  Medical  Colleges,  is  doing  un- 
told harm  to  hundreds  of  young  men  who  might 
make  successful  mechanics,  farmers,  or  busi- 
ness men,  instead  of  disappointed,  starving  law- 
yers or  doctors.  The  Canadian  Mcdica!  Re- 
vino,  in  an  editorial  headed  '  Wanted — .A.  Medi" 
cal    Practice,'    draws  a  dark  [licture  of    pros' 


THE  CANADA  MEDICAL  RECORD. 


143 


pects  of  success  in  medicine.  When  we  con- 
sider that  the  proportion  of  doctors  is  as  i  to 
100  of  the  population,  on;!  that  tlie  medical 
schools  of  the  cities  are  crowded  with  liundreds 
of  boys  scarcely  more  than  children,  who  are 
galloping  carelessly  into  a  profession  which 
doesn't  even  promise  a  living,  we  may  well  con- 
sider it  time  to  utter  a  word  of  warning  to  par- 
ents who  have  their  sons'  welfare  at  heart." 

You  often  hear  people  say  "  Look  at  the  fine 
houses  medical  men  live  in."  In  the  past,  no 
doubt,  such  was  the  case  ;  but  at  present  a 
vast  number  of  city  doctors  are  running  board- 
ing houses  or  taking  rooms  witli  families.  A 
friend  of  the  writer,  who  recently  advertised 
for  lodgings,  received  forty  replies,  of  which 
eighteen  were  from  medical  men  in  the  city, 
offering  every  inducement  to  a  prospective 
boarder  or  lodger.  In  the  editorial  referred  to 
we  find  the  following  : 

"  One  doctor  to  every  900  inhabitants  is  an 
abnormal  proportion — greater  than  that  of  law- 
yers, who  are  as  i  to  1,100.  What  are  the 
causes?  Over  education  is  the  main  one. 
Ploughboys  and  mechanics  aspire  to  higher 
things,  and  get  them  :  so  that  poor  doctors  take 

the   place    of  good    mechanics There   are 

medical  men  in  this  city  who  are  not  making 
$2  a  day,  mechanics'  wages,  yet  they  pour  in." 
The  writer  can  assure  the  readers  of  The  Mail 
and  Empire  \\\zX  there  are  over  100  medical 
men  in  the  city  who  do  not  make  even  $2  a  day, 
and  meets  with  many  clever  men  in  the  prime 
of  life  who  eight  or  nine  years  ago  were  doing 
fairly  well,  and  find  themselves  scarcely  able  to 
support  themselves  by  their  profession  at  pre- 
sent.    This  is  as  true  of  law  as  of  medicine. 

The  struggle  for  existence  is  so  keen  that 
every  day  we  see  the  pitiable  and  degrading 
sight  of  men  struggling  and  fighting  for  lodge 
practice  at  one  dollar  per  head  a  year. 

You  may  rest  assured  of  one  fact,  that  everv 
young  man  who  is  making  $50  a  month  in  busi- 
ness or  teaching  school  is  much  better  off  and 
can  save  more  money  than  can  the  possessor  of 
a  legal  or  medical  degree  who  finds  it  necessary 
to  keep  up  a  brave  front  on  an  insufficient  in- 
come. You  don't,  as  a  rule,  see  the  young  men 
in  the  cities  going  into  professions.  It  is  the 
peasantry  who  desire  to  live  in  the  cities  and 
imagine  the  streets  are  paved  with  gold.  Let 
the  boys  stick  to  the  farm  or  stock  raising,  and 
help  to  build  up  their  country,  instead  of  be- 
coming unproductive  drones  of  society,  drag- 
ging out  a  sour,  embittered  existence.     To  the 


young  man  who  enters  the  portals  of  a  medical 
college,  with  the  few  exceptions  of  those  having 
great  influence  and  personal  ability,  the  writer 
ivould  say  '.  "  Abandon  all  hope  who  enter 
here." 


MEDICAL  ITEMS. 

Sir  William  Savory,  the  celebrated  London 
surgeon,  and  for  many  years  an  examiner  of 
the  Royal  College  of  Surgeons,  has  recently 
died  at  an  advanced  age. 

Mr.  J.  W.  Hulke,  who  was  President  of  the 
Royal  College  of  Surgeons  at  the  time  of  his 
dea^h,  has  also  passed  away. 

A  new  medical  journal.  La  C/inique,hvi%  been 
established  by  Dr.  H.  M.  Duhamel. 

Dr.  Roddick,  who  has  been  having  a  delight- 
ful trip  to  the  Mediterranean,  is  shoitly  expected 
to  return  to  the  city. 

l^r.  E.  W.  Campbell's  beautiful  residence  on 
Sherbrooke  St.,  Montreal,  will  be  ready  for 
occupation  next  month. 

Beaver  Hall  Terrace,  Montreal,  which  was 
for  many  years  first  the  fashionable  residence 
quarter  of  rich  merchants,  then  became  the 
stronghold  of  the  principal  doctors,  was  then 
gradually  abandoned  to  the  dentists,  and  is 
now  being  filled  with  shops.  Union  Avenue 
is  going  through  the  same  process,  the  older 
physicians  retiring  to  Sherbrooke  Street  and 
other  residence  streets  in  the  West  End.  The 
centre  of  the  city  has  moved  at  least  a  niile 
westward  during  the  last  ten  years. 


BOOK  NOTICES. 

Diseases  of  the  Ear. — A  text-book  for  practi- 
tioners and  students  of  Medicine,  by  Ed- 
ward Erandford  Dench,  Ph.B.,  M.D., 
Professor  of  Diseases  of  the  Ear  in  theBel- 
levue  Hospital  Medical  College  ;  Aural  Sur- 
geon New  York  Eye  and  Ear  Infirmary  ; 
Fellow  of  the  American  Otological  Society, 
of  the  New  York  Academy  of  Medicine,  of 
the  New  York  Otological  Society,  of  the 
New  York  Couniy  Medical  Society,  etc. 
With  eight  colored  plates  and  one  hundred 
and  fifty-two  illustrations  in  the  text.  New 
York:  D.  Appleton  &  Company,  1894. 
The  author  gives  the  aims  and  scope  of  the 
work  in  the  following  terms  : 

In  the  preparation  of  the  present  work  it 
has  been  my  aim  to  adapt  it  to  the  needs  both 
of  the  general  practitioner  and  the  special  sur- 
geon. For  this  reason  minute  pathology  has 
not  been  considered  extensively. 

In  detailing  the  various  manipulative  proce- 
dures, I  have  preferred  to  err  on  the  side  of 
prolixity,  for  the  benefit  of  those  not  familiar 
with  the  subject.  It  has  also  been  my  purpose 
to  keep  constantly  before  the  reader,  the  fact 
that  many  diseases   of  the  ear   should   not  be 


144 


THE  CANADA  MEDICAL  RECORD. 


considered  by  themselves,  for  the  reason  that 
they  are  often  local  manifestations  of  systemic 
condition. 

Many  works  upon  otolo.a:y  have  failed  to 
emphasize  the  importance  of  a  thorough  func- 
tional examination  ;  and  none  have  placed  the 
results  of  recent  investigations  at  the  disposal 
of  the  reader  in  such  a  manner  as  to  enable  him 
to  use  them  in  diagnosis.  In  consequence,  I 
have  written  at  lengtli  upon  this  subject. 

In  advocating  operative  procedures  upon  the 
middle  ear,  and  in  devoting  much  space  to  the 
subject  of  middle  ear  operations,  I  am  aware 
that  I  shall  not  have  the  support  of  many  dis- 
tinguished colleagues.  As  a  careful  re.iding 
of  the  chapter  will  show,  I  have  written  from 
personal  exjierience  ;  and  if  my  results  differ 
from  those  of  other  operators,  I  suggest  that 
the  selection  of  cases  suitable  for  operation, 
according  to  the  princii)les  detailed  in  previous 
chapters,  may  account  for  the  favorable  outcome 
of  the  operations. 

In  illustrating  the  gross  pathological  lesions 
of  the  conducting  mechanism  and  the  various 
manipulative  measures  instituted  for  their  relief, 
1  have  adopted  the  plan  of  sliowing  the  auricle, 
meatus,  and  middle  ear  in  the  same  drawing. 
The  drawings  are  of  natural  size,  and  the 
technique  of  tiie  various  procedures  seems  to 
be  made  more  clear  in  this  manner  than  by 
any  other  method. 

In  tlie  colored  plates  of  the  membrana  tym- 
pari,  the  adjacent  portion  of  the  meatus  is  also 
shown,  tiius  reproducing  as  completely  as  pos- 
sible the  picture  seen  upon  speculum  examin- 
ation, and  rendering  the  relative  position  of 
the  parts  more  iiitelligible. 

The  absence  of  extensive  bibliographical 
citations  may  seem  a  defect,  but  in  a  work 
intended  as  a  clinical  guide,  a  complete  biblio- 
graphy would  be  impossible,  and  unless  com- 
plete it  would  be  useless.  No  attempt  has 
been  made,  therefore,  to  collate  the  entire  liter- 
ature of  any  subject,  and  the  citations  have 
been  limited  to  those  necessary  to  give  indi- 
vidual investigators  the  i)roper  credit  for  their 
researches. 
»  We  may  add  that  the  work  does  credit  alike 
to  the  author  and  publishers.  It  is  one  of  the 
most  complete  works  on  the  subject  that  we  have 
yet  seen,  and  the  printing  and  binding  are  up 
to  the  usual  high  standard  maintained  by  the 
Appletons.  It  may  be  obtained  from  tiicir 
agent,  Geo.  N.  Morang,  Traders  Bank  build- 
ing. 63  Yonge  Street,  Toronto. 

PUBLISHERS  DEPARTMENT. 

C  .\  S  C  A  R  A  S  A  G  K  A  D  A . 
Among  the  inapy  drugs  wliich  have  l)een  brought  to 
the  notice  of  the  profession  during  the  last  ten  or  fifteen 
years,  liow  few  have  come  to  stay?  The  majority  of 
them  have  had  but  a  brief  period  of  popularity,  and 
after  having  been  tried  and  having  disappointed  those  who 
pinned  their  faith  to  them,  they  have  finally  disappeared. 


This  fate  has  not  fallen  to  Cascara  ;  it  has  been  found 
to  be  such  a  reliable  and  gentle  laxative  or  cathartic, 
and  acting  in  such  small  doses,  that  it  has  V>ecome  a 
general  favorite  with  the  profession,  which,  now  that  it 
has  proved  the  virtues  of  the  drug,  would  be  loth  to  be 
without  it.  If  any  of  our  readers  have  not  yet  employed 
Cascara,  we  would  urge  them  to  give  it  a  trial,  as  there 
is  now  no  longer  the  slightest  doubt  as  to  its  value. 
Hitherto  the  only  objections  that  could  be  raised  against 
it  were  its  bitterness  and  the  uncertainty  as  to  its  elTec- 
tive  dose,  more  being  required  to  produce  the  effect 
where  certain  preparations  of  it  were  used.  These  objec- 
tions have  been  entirely  removed  by  Messrs.  Kenneth 
Campbell  &  Co.,  wholesale  druggists  of  Montreal,  who 
have  placed  a  fluid  extract  of  Cascara  on  the  maiket, 
the  bitterness  of  which  is  entirely  disguised,  and  which 
we  have  invariably  found,  after  repeated  trials,  to  be 
effective  at  the  uniform  dose  of  ten  minims  3  times 
a  day.  Added  to  preparations  of  iron,  it  entirely  coun- 
teracts the  latter's  constipatory  effect,  and  enables  persons 
to  take* iron  mixtures  who  for  the  above  reason  were 
formerly  unable  to  take  them.  Cascara  also  acts  like  a 
charm  in  many  cases  of  hemorrhoids,  which,  as  we  have 
often  pointed  out  in  these  columns,  are  in  many  cases 
due  to  constipation  alone.  By  softening  the  solid 
masses  of  frecal  matter,  the  obstruction  to  the  circulation 
in  the  hoemorrhoidal  veins  is  removed,  and  the  liitle 
blood  tumor  gradually  disappears.  Care  must  be  taken 
to  employ  the  smallest  possible  dose,  as  active  catharsis 
in  hto.morrhoids  greatly  increases  the  patient's  sufferings. 
Cascara  is  an  especial  boon  to  those  patients  with  con- 
stipation who  cannot  swallow  a  laxative  or  cathartic  pill. 
It  is  also  claimed  fox  it  that  iis  effect  is  permanent, —  hat 
is,  that  after  having  taken  it  for  a  time,  the  intestines 
become  so  loned  up  that  they  no  longer  require  any 
artificial  stimulus  ;  but  for  this  we  cannot  answer  posi- 
tively. All  we  can  say  is  that  Kenneth  Campbell's 
Cascara  is  a  pleasant  and  reliable  laxative.  We  may 
add  that  these  remarks  are  written  more  for  the  sake  of 
our  readers  than  for  the  benefit  of  the  manufacturer, 
although  we  have  known  him  and  used  his  preparations 
for  nearly  twenty  years. 

NEW  REMEDY  IN  OPHTHALMOLOGY. 

The  newest  remedy  in  ophthalmological  practice  is 
Antikamnia  It  will  afford  prompt  relief  in  those  cases 
of  intense  pain  in  and  about  the  eyes,  where  heretofore 
nothing  liut  the  strongest  anodynes  would  answer. 
This  is  well  illustrated  in  the  case  of  the  Editor  of  the 
Southern  Medical  Record,  Dr.  D.  H.  Howell.  Under 
date  of  Dec.  5th,  1894,  Dr.  Howell  writes  that  he  has 
been  a  great  sulTerer  with  his  eyes  fir  a  number  of 
months,  at  times  suffering  the  most  intense  pain.  After 
trying  a  number  of  remedies  in  vain,  he  thought  he 
would  try  Antikamnia.  Relief  followed  in  less  than 
two  hours,  and  now  he  says  he  carries  Antikamnia  in  his 
pocket  all  the  lime. 

LITERARY  NOTE. 

"The  Beautiful  Models  of  Paris,"  in  the  March 
Cosmopolitati,  satisfy  a  long-felt  curiosity  in  regard 
to  the  women  who  have  been  posing  for  the  world's 
famous  paintings.  The  Cosmopolitan  has  carefully 
gathered  a  collection  of  the  most  famous  of  these 
portraits,  and  used  them  to  illustrate  an  interesting 
article  by  a  distinguished  French  critic,  Fr.  Tl.i6- 
bault  Sisson.  Nor  does  the  beauty  of  the  originals 
fall  short  of  the  ideal  on  the  painter's  canvas.  In  the 
same  number  is  a  delightful  article  about  the  famed 
seagirt  isle,  for  so  many  centuries  a  fortress  and  ptison — 
^lont-Saint-Michel.  "Pearl-Diving  and  Its  Perils,'" 
l)y  an  English  naval  oflicer,  written  from  personal  ex- 
periences, is  i^erhaps  the  most  thrilling  tale  of  explora- 
tion of  the  ocean's  depths  ever  put  on  paper.  The 
fiction  of  this  number  is  unusually  entertaining. 


ktm^j 


Vol.  XXIII. 


MONTREAL,  APRIL,  1895. 


No.  7. 


ORIGINAL  COMMUNICATIONS 

Abstract  of  a  Paper  entitled  Ob- 
servations on  the  Treatment  of 
Fibroids  of  the  Uterus Ho 

SOCIETY  PROCEEDINGS. 

ISlontreal  Medico-Cbirurgical  Soci- 
ety   146 

Spitting  on  Floors  W7 

Discussion  on  the  Management  of 

the  Third  Stage  of  Labor 147 

Academie  de  Medeciue 155 

Sudden  Death  on  the  Bicycle 155 


PROGRESS  OF  SCIENCE- 

Treatment  of  Strangulated  Ilfrnia. .  15C 
Ett'eets  of  Thyroid  Administration.  156 
Diagnosisof  Tuberculosis  in  Children  156 
Chloral  Hydrate— Some  of  Its  Uses..  156 
Some  Kecent  Views  on  Appendicitis.  157 


Treatment  of  Potfs  Disease   158 

The  Antitoxin  Treatment  of  Diph- 
theria    159 

Pernicious  Anannia  at  the  age  of 

Twenty-one  160 

Meningitis  of  Obscure  Causation. ...  160 

A  Case  of  Taenia  Nana  in  a  Child 160 

The  Value  of  Sugar  and  the  Effect 

of  Smoking  on  Muscular  Work 160 

Scorbutus  in  Infants 161 

Subcutaneous  Injection  of  Artificial 

Serum  in  Serious  Hemorrhage 161 

Class-Koom  Notes.  162 

Therapeutic  Briefs 163 

EDITORIAL 

Canada  Medical  Association 164 

The  International   Language  of  the 

Future 164 

The  Outlook  for  Medical  Students. .  164 

The  Duty  of  Naval  Surgeons  165 

The  New  York  Academy  of  Medicine  165 
Patent  Medicines 165 


Medical  Items 166 

BOOK  NOTICES. 

Clinical    Gynecology,  Medical  ;ind 

Surgical  166 

Saunders'  New  Aid  Series 167 

A  Manual  of  Bandaging ...     167 

Therapeutic  Suggestion  in  Psycho- 
pathia  Sexualis 167 

PAMPHLETS  RECEIVED. 

Resection  of  the  Kidney 168 

Impressions    of   American  Medical 

Schools 163 

The  Surgical  Treatment  of  Inguinal 

Hernia.... 168 

Publishers  Department 168 


fngfnal    (|^ommuntcatrons. 


ABSTRACT    OF   A    PAPER   EN- 
TITLED OBSERVATIONS 
ON  THE  TREATMENT 
OF  FIBROIDS  OF 
THE  UTERUS. 

Dr.  O.   S.   Phelps    of  New  York    {Am. 
Medico-Surg.  Bull.)    reports  an  unusually 
complicated  case  of  uterine  fibroid  in  a  girl 
17  years  of  age  who  came  under    his  care 
in   July,    1894.     She    was  sent   from    the 
West  to  New  York  by  the  family  physician 
to    have  a    hysterectomy   performed,  and 
came     directly    to    his    sanitarium.     The 
tumor  was  8  to  lo  centimeters  in  diameter, 
and  crowded    the  uterus   well  over  to  the 
left  side.     The  uterine    cavity  measured    5 
inches,  and  the  organ  with  its  appendages 
was   surrounded  and    bound  down    by  an 
inflammatory  exudate.       The  bladder  was 
impinged    upon  so  that  it  could  not  hold 
more    than  one    or  two    ounces    of  urine, 
causing  the  patient  great  agony  to  evacuate 
it.     The  whole  mass,  including  tumor,  exu- 
date,   uterus    and    appendages,   filled    the 
pelvis,  and  rose  well  up  to  the   umbilicus. 


The  patient  was  much  emaciated,  weighed 
60    lbs.  (normal  weight  125  pounds),  could 
not    stand  or   walk,  nor  could  she   turn  in 
bed     without   great    pain.     Temperature 
100°    to    103°.     Dr.   A.     H.    Goelet   was 
called  in  consultation,  and    confirmed  the 
diagnosis  ;  he  also  agreed  that  no  operation 
could   be    considered     at    that    time,    but 
thought    ligation    of    the  uterine   arteries 
might  be  resorted  to  later.     The  treatment 
adopted  was  the  high    tension  faradic  cur- 
rent, I  5  minutes  thrice   daily,  vagino-sacral 
and      abdominal.     At   each      seance  the 
temperature  was  reduced  ^   to  i  degrees, 
lasting  I  to  2  hours.     A  system  of  feeding 
was  adopted  under  the  guidance  of  micro- 
scopical   observations    of   the    blood    and 
secretions  to  determine  the  correct    choice 
of  food.     In  two    months  the  temperature 
remained     normal,    and    the     weight  had 
increased    30    lbs.     Galvanism    was    then 
begun,  with  anode  to  tumor  per  vaginum, 
by  means  of  a  special  clay  electrode   with 
cathode     closely   adapted  to   tumor   over 
abdomen  ;      20   to     30     milliamperes     of 
current,    7    to      10      minutes     every     five 
days.     January  i  5,  tumor  was  reduced  to  a 
mere    nodule,    about  the  size  of  a  small 


146 


THE   CANADA    MEDICAL  RECORD. 


walnut,  exudation  gone,  uterine  cavity 
measured  2^  inches.  Patient's  weight 
was  then    125  pounds. 

Conclusions,  the  writer  ascribes  the 
favorable  results  in  this  case  : 

First,  to  a  systematic  plan  for  res- 
toring the  nutrition,  under  .'■uch  favorable 
conditions  as  are  afforded  by  a  sanitarium. 

Second,  to  the  persistent  use  of  the 
high  tension  faradic  current  to  allay  pain, 
reduce  inflammation,  and  induce  absorp- 
tion. 

Third,  to  the  galvanic  current,  so 
appHed  as  to  concentrate  its  action  upon 
the  fibroid  growth. 

sccrcfg     jliroceebtngs. 


MONTREAL  MEDICO-CHIRURGICAL 
SOCIETY. 

Stated  Meeting^  November  t^o,  1894. 
G.  P.  GiRDwooD,  M.D.,  President,  i.m  the 

Chair. 
Dr.  Adami,  reporting  on  Dr.  Bell's  cases, 
remarked  that  with  regard  to  the  first  specimen, 
the  porlion  of  the  intestine  removed  had  been 
examined  by  Dr.  Shaw,  who  made  a  series  of 
sections,  wliich  showed  that  the  cicatricial  band 
in  the  intestines  was  not  of  the  nature  of  sim- 
ple fibrous  tissue,  but  of  fairly  fibrous  columnar- 
celled  carcinoma.  The  posi-mortem,  which  was 
made  several  hours  after  death,  took  ])lace  on 
Sept.  15th.  Upon  opening  the  aljdomen,  acute 
inflammation  was  noticed  ihroughouttheabdom- 
inal  cavity.  Faices  were  first  seen  coming  up 
through  the  region  where  the  drainage  tube  had 
been,  with  gas  bubbling  up  through  them. 
Working  down  in  this  region  they  came  to  the 
sigmoid  flexure,  and  the  portion  of  the  intes- 
*  tine  where  the  "button"  liad  been  inserted, 
and  found  that  sloughing  had  taken  place  be- 
tween the  upper  half  of  the  button  and  the  at- 
tached intestine,  which  opened  up  the  bowel, 
and  allowed  its  contents  to  escape.  The  mesen- 
tery in  tlie  region  of  the  sloiigli  was  enormously 
thickened.  It  seemed  to  Dr.  Adami  that  the 
slough  had  occurred  more  in  the  region  of 
the  rectum  than  in  that  of  the  sigmoid  flexure. 

Dr.  Shepherd  congratulated^Dr.  Bell  on  his 
success  in  the  last  case.  Tlie  fital  result  in  the 
first  he  thought  was  not  the  fault  of  the  opera- 
tor, but  was  owing  to  circumstances  over  which 
he  had  no  control.  It  would  be  interesting  to 
know  what  caused  the  non-union  of  the  bowel. 


He  had  performed  several  operations  of  resec- 
tion, but  had  always  done  the  end  to  end  su- 
ture. His  difficulties  had  been  with  the  mesen- 
tery, which  tears,  especially  in  regions  where  it 
is  short,  such  as  near  the  ileo-c?eca]  valve,  fhe 
use  of  the  clamp  is  another  difiiculty.  Very 
little  pressure  is  required  to  keep  the  bowel 
closed  while  the  resection  is  ])rogressing,  and 
some  instrument  which  will  exercise  exactly  the 
right  amount  is  much  needed.  He  either  used 
a  rubber  tube,  or  the  hands  of  the  assistant; 
the  latter  are  best,  but  they  are  ai)t  to  be  in  the 
way  ;  the  rubber  tube  often  exercises  too  much 
pressure.  It  is  not  the  actual  approximation 
of  the  bowel  which  takes  up  the  time,  but  these 
other  difliculiies,  which  will  exist  just  the  same, 
notwithstanding  the  use  of  the  Murphy  button. 
Dr.  James  Bell,  after  explaining  the  manner 
in  which  the  Murphy  button  was  used,  re- 
marked that  in  the  old  method  of  simply  sutur- 
~ing,  he  always  felt  considerable  uneasiness  as 
to  the  danger  of  the  sutures  giving  way.  It  was 
true  he  never  had  such  an  accident  occur  in  any 
of  his  cases  ;  but  when  one  considered  the  fria- 
ble nature  of  the  tissues  united,  it  was  not  an 
improbable  danger,  and  the  increased  security 
wliichthe  "button  "gave  in  this  respect  was  an 
advantage  in  addition  to  its  saving  of  time.  In 
concluding.  Dr.  Bell  remarked  that  he  began  to 
use  tlie  Murphy  button  with  some  prejudice 
against  it,  but  after  trying  it,  he  was  bound  to 
admit  it  a  very  useful  instrument  indeed. 

Dr.  Adami,  commenting  on  Dr.  Bell's  theory 
as  to  the  cause  of  the  sloughing  in  his  fatal  case, 
said  that  at  the  post-mortem  the  glass  lube  was 
found  rather  to  one  side  of  the  bowel,   towards 
the  middle  line.     It  was  found  passing  down  to 
the  portion  of  the  bowel  which  held  the  button, 
which  latter  could  be  felt  at  the  end  of  the  tube 
when  it  was  pressed  down  into  the  wound.     It 
is    possible,  therefore,  that    there    might    have 
been  rome   undue  pressure  on   the   bowel   be- 
tween the  button  and  the  tube,  but  as  the  tube 
at  most  could,  from  its  position,  press  against 
the  inner  (or  medial)  side  of  the  intestine,  and 
the  gangrene  was  equall)  developed  all  round 
(  the  organ,  save  at  the  mesentery,  it  sf  emed  to 
j  him  more  probable  thai  the  cause  of  the  slough- 
;   ing  was  the  pressure  of  the  elar.tic  ligature  on 
{   the  intestine  during  the  operation. 
I       Dr.   Armstron(.   remarked  that  he  had  no 
j   special   experience   with    the    Murphy  button ; 
I  but  that  he  had  this  last  summer  seen  one  posi- 
j   mortem  where  it  had  been   used,  and   where  a 
I   good  deal  of  sloughing  had  taken  place  around 
'   it.     He  frankly  admitted  himself  a  little  preju- 
I   diced  against    the   ir.strument.      He    did   not 
I   think  it  saved  much  time,  it  cou'd  only  econo- 
mize in  this  way,  in  the  matter  of  suturing,  and 
,in  opeiations  of  this  kind,  his   experience  was 
that  it  was  not  the  end  to   end  suturing  which 
caused  most  trouble  in  competent  hands,  but 
the  dealing  with  the  mesentery.     The  old  me- 


THE   CANADA    MEDICAL    RECORD. 


147 


thod  had  given  good  results,  and  when  pro- 
perly performed,  leakages  from  the  bowel  very 
seldom  followed  the  operation.  He,  however, 
could  conceive  of  cases  where  the  button  might 
be  an  advantage,  namely,  when  resection  had 
to  be  performed  in  portions  where  the  bowel 
was  not  easily  accessible  to  the  hands,  such  as 
deep  down  in  the  pelvis  ;  but  in  any  situation 
where  the  intestines  could  be  brought  up,  and 
conveniently  sutured,  he  would  prefer  the  old 
method.  His  great  objection  to  the  "  button  " 
was  the  manner  in  which  it  separated.  This 
must  of  necessity  be  by  a  process  of  ulceration, 
which  seemed  to  him  a  very  undesirable  con- 
dition occurring  around  the  two  ends  of  a  lately 
united  bowel. 

Dr.  James  ])Ell  closed  the  discussion  by 
answering  some  of  the  principal  objections  to 
the  use  of  the  Murphy  button,  and  giving  a 
brief  resume  of  the  complications  existing  in 
his  fatal  case.  It  was  easy,  he  said,  to  see 
why  the  button  did  not  in  this  case  come  away. 
In  the  first  place,  he  had  narrowed  the  bowel 
before  it,  and  in  the  meantime  the  stricture 
which  occurred  in  the  sigmoid  flexure  effectu- 
ally prevented  it.  With  regard  to  the  saving 
of  time,  this  came  in,  in  the  fact  that  in  the 
purse  string  suture,  there  were  not  more  than 
a  dozen  needle  punctures  to  be  made.  The 
only  suture  that  required  to  be  accurate  was 
that  which  brought  the  two  folds  of  the  mesen- 
tery together.  This  certainly  saved  time  over 
tlie  ordinary  suturing  method,  where  the  needle 
had  to  be  entered  four  or  five  times  as  often. 
Referring  to  the  first  case,  he  said  the  sequence 
of  events  was  as  follows:  (i)  A  perfectly 
healthy  man  taken  with  diarrhoea;  (2)  follow- 
ing this  was  constipation,  with  evidence  of 
obstruction,  of  pain,  and  of  haemorrhage.  At 
the  first  operation  it  was  found  that  the  obstruc- 
tion existed  in  the  small  intestine,  loops  of 
which  had  been  destroyed  by  a  destructive 
ulceration.  At  this  time  there  existed  no  ob- 
struction in  the  descending  colon  or  rectum, 
and  after  the  disease  of  the  small  bowel  had 
been  removed,  perfectly  formed  stools  were 
passed  regularly,  showing  the  functions  of  the 
intestinal  tract  to  be  normal.  Now,  the  inter- 
esting part  of  the  problem  is,  how  all  this 
trouble  could  have  developed.  Dr.  Bell's  idea 
was  that  it  must  have  originated  in  the  perito- 
neum over  the  brim  of  the  pelvis,  and  that  it 
afterwards  extended  to  the  bowel.  From  a 
mechanical  point  of  view  this  seemed  the  most 
probable  sequence  of  invasion. 

Spitting  on  Floors. — The  following  resolution 
was  moved  by  Dr.  Mills,  seconded  by  Dr. 
McCoNNELL,  and  carried  unanimously  : 

Inasmuch  as  spitting  on  floors  is  a  practice 
not  only  filthy  but  dangerous  to  health. 

It  is  hereby  resolved,  to  urge  upon  the  Mon- 
treal Street  Railway  Company  the  desirability 
of  prohibiting  spitting  on  the  floors  of  their 
cars  by  notices  posted  prominently. 


Discussion  on  the  Management  of  the  Third 
Stage  0/  Labor.— Dr.  ].  C.  Cameron  opened 
the  discussion.  The  third  stage  of  labor  being 
the  separation  and  expulsion  of  the  placenta 
and  membranes,  it  became  necessary  to  enquire, 
what  were  the  placenta  and  membranes  ?  to 
what  were  they  attached,  and  how  were  they 
attached  ?  He  described  briefly  the  decidual  lin- 
ing of  the  uterine  cavity  which  prepared  for  the 
reception  of  the  impregnated  ovum  ;  the  arrival 
of  that  ovum,  with  its  chorionic  covering,  plant- 
ing itself  in  the  portion  of  the  decidua,  after- 
wards called  serotina,  and  the  development  of 
the  decidua  reflexa;  the  parttaken  by  th  i  decidua 
in  the  formation  of  the  placenta  ;  the  formation 
of  the  amniotic  sac  ;  the  growth  of  the  ovum 
until  itfinally  fillsthe  whole  uterine  cavity,  and 
unites  the  decidua  reflexa  with  the  decidua  vera, 
or  original  decidual  lining  of  the  uterine  wall. 
The  membranes  then  were  three-fold,  and  toge- 
ther they  form  a  tripartite  bag  which  is  filled  with 
fluid  in  which  floats  the  embryo.  Considering 
the  character  and  texture  of  the  separate  mem- 
branes, and  taking  them  in  the  order  of  their 
occurrence  commencing  from  the  inside,  he  said 
the(i)  amnion  was  elastic  and  strong  ;  (2)  the 
chorion  was  thicker  and  more  friable,  and  con- 
nected very  intimately  with  the  (3)  decidua 
which  was  composed  of  two  layers, — an  internal 
dense  and  firm,  an  external  of  a  more  spongy 
character.  Summing  up  the  character  of  the 
membranes  as  to  strength,  the  latter  decreases 
from  within  outward  ;  the  amnion  very  strong, 
the  chorion  less  so,  the  decidua,  being  least  of 
all,  has  very  little  cohesion. 

When  labor  is  about  to  begin,  the  uterus  is 
an  ovoid  body,  with  walls  of  tolerably  equal 
consistence,  except  at  the  lower  part  where  the 
body  joins  the  cervix.  About  one-fifth  of  its 
cavity  is  lined  witii  placenta,  and  the  remaining 
four-fifths  with  the  membranes.  The  cervix  at 
this  time  is  completely  closed,  but  with  the 
onset  of  pains,  the  bag  of  waters  is  forced  down 
upon  the  internal  os,  and  gradually  opens  up 
the  cervix  by  a  process  of  bulging.  In  order 
to  bulge  and  dilate  the  cervix,  the  membranes 
must  separate  from  their  uterine  attachments; 
during  the  first  stage  we  find  that  they  are  se- 
parated from  the  lower  uterine  segment.  At 
the  beginning  of  the  second  stage  they  rupture, 
and  there  is  no  further  separation  of  the  mem- 
branes till  after  the  birth  of  the  child.  At  the 
beginning  of  the  third  stage  we  find  the  uterus 
reduced  considerably  in  size,  and  differentiated 
into  two  parts,  an  upper  thick-walled  contrac- 
tile part,  a  lower  thin-walled  dilatable  part ;  the 
function  of  the  first  is  to  contract,  and  expel 
the  placenta  ;  of  the  second,  to  expand,  and  give 
passage  to  it.  There  is  no  foundation  for  the 
statement  that  the  placenta  begins  to  separate 
normally  when  the  head  is  being  born.  How 
then  does  the  separation  take  place  ?  Let  us 
first  recall  how  the  different  membranes  are 
joined   together.     The  amnion   is   loosely  at- 


148 


THE  CANADA  MEDICAL  RECORD. 


tached  to  the  chorion  ;  the  chorion  is  intimately 
connected  with  the  decidua  ;  and  the  decidua 
is  attached  to  the  uterine  wall  in  pretty  much 
the  same  manner  as  the  mucous   membrane  is 
attached  to  the  non-pregnant  uterus.     Having 
then  very  firm  union  between  the  chorion  and 
decidua,  and  a  more  feeble  union  between  the 
(horion  and  amnion,  and  between  the  decidua 
and  the  uterine  wall,  it  is  only  natural  to  expect 
that  the  lines  of  cleavage,  or  separation  of  the 
membranes.would  be  either  between  the  amnion 
and  chorion  or  between  the  decidua  and  uterine 
wall.  The  latter  is  where  separation  usually  takes 
place.     What  is  the  mechanism  of  the  separa- 
tion of  ])lacenta  and  membranes  from  the  uter- 
ine wall?     Various  facto  s  are  concerned  :  (i) 
the  contraction  of  the  uterus  ;  (2)  die  retraction 
of  the  uterus  ;  (3)  the  effusion  of  blood.     Dr. 
Cameron    then    dwelt    upon  the    two   theories 
which  were  put  forward   to  explain    the  expul- 
sion of  the  placenta.     The  one    claimed   that 
the    contractions   of  the  uterus    during   labor 
caused  the  placenta  to  arch  or  bulge  downwards 
into  the  uterine  cavity,  causing  a  partial  separa- 
tion from  the  uterus  with  effusion  of  blood  into 
the  concavity  of  the  arch,  between  the  placenta 
and  uterus.    The  pouring  out  of  this  blood  caus- 
ed by  its  pressure  a  still  further  increase  of  the 
arching  process,  until  finally  the  whole  placenta 
separated  and  descended  with  its  foetal   aspect 
presenting.     The  other  theory  was  that  rupture 
of  vessels  played  no  part  in  the  separation  and 
expulsion,  which    were  solely  the  result  of  the 
contraction  and  retraction  of  the  uterus.     The 
speaker  thought  both  explanations   were  right 
in  certain  cases,  the  situation  of  the  placenta 
as  well  as  its  extent  determining  the  mechanism 
of  separation  and  expulsion.     When  the  uterine 
wall  contracts,   the  placenta  contracts  also,  it 
moves  with,  but  not  to  the  same  extent  as,  the 
uterus.      The  placenta  can  be  diminished   in 
area  by  contraction  about  one-half  on  the  aver- 
age.    Having  reached  the  limit  of  its  reduction 
in    size,  it  remains  rigid,  while  the  uterus  goes 
on  contracting,  and  draws    itself  off  from  the 
placenta.     Some  authors  believe  this  separation 
begins  in  the  centre,  some  at  the  side.     It  was 
,then  explained  how  it  may  occur  in  either  way. 
In  studying  the  mechanism  of  separation,  it  is 
important  to  remember  that  the  whole  uterus 
contracts,  not  the  placenta  only,  so    that   not 
only  does  the  placental  surface  decrease  in  size, 
but  the  whole  uterus  contracts  and  grasps  it  on 
all  sides.     The  method  of  separation  depends 
largely   upon    whether    the    uterus    contracts 
upon    the    placenta    evenly    all    around,     or 
whether    the    contraction    is    irregular ;    and 
upon  whether  the  placenta  is  uniformly  adher- 
ent to  the  uterus  or  has   some  i)oints  at  which 
it  is  more  firmly  adherent  than  others.     Irregu- 
lar uterine  action  and  abnormal  or  pathological 
attachment  of  the  placenta  modify  the  mechan- 
ism  of  the   separation    and   expulsion    of  the 
placenta. 


Another  point  to  be  borne  in  mind  is  that 
there  is  not  normally  a  true  uterine  cavity  into 
which  the  placenta  may  bulge.  As  soon  as  the 
child  is  born,  the  uterus  contracts  and  the 
anterior  wall  comes  against  the  posterior  wall. 
It  is  this  absence  of  an  actual  cavity  which 
makes  the  theory  of  the  arching  of  the  ])lacenta 
untenable  in  most  cases;  sometimes  when  it  is 
situated  directly  over  the  fundus,  its  central 
portion  may  bulge  down  towards  the  os  which 
is  the  point  of  least  resistance.  But  if  the 
placenta  is  situated  upon  the  side  of  the  uterus, 
arching  does  not  take  place,  but  the  lower  edge 
glides  downwards  and  presents  at  the  os. 
Coming  then  to  the  separation  and  expulsion 
of  the  membrares,  it  will  be  remembered  that 
the  portion  over  the  lower  uterine  segment  was 
separated  during  the  first  stage  ;  the  rest  which 
constitutes  about  four-fifths  of  liie  whole  is 
attached.  The  membranes  are  separated  (i) 
by  retraction  of  the  uterus  during  the  second 
stage  and  the  beginning  of  the  third  stage.  As 
the  uterus  is  emptied,  it  retracts  by  drawing  the 
uterine  wall  together;  the  membranes  are  thus 
thrown  into  wavy  folds  which  are  most  marked 
close  to  the  uterine  surface  or  in  the  decidual 
layer.  The  crest  of  each  of  these  folds  in  the 
decidua  tends  to  separate  from  the  uterine 
wall,  and  a  little  haemorrhage  follows,  which 
still  further  separates  the  membranes,  'i'his, 
however,  is  only  capable  of  carrying  the  separ- 
ation a  certain  distance,  and  the  process  has 
to  be  completed  by  the  traction  of  the  placenta 
which  drags  the  membranes  after  it  as  it  de- 
scends. 

We  have  here  a  fair  statement  of  the  jiroblem 
before  us.  The  mechanism  varies  according 
to  where  the  placenta  is  situated  on  the  uter- 
ine wall,  its  extent,  the  existence  of  patho- 
logical adhesions,  the  uniformity  of  uterine  con- 
traction, the  relative  strength  of  the  union 
between  amnion  and  chorion  as  compared  with 
that  between  chorion,  decidua  and  uterine 
wall. 

In  concluding  his  introduction,  Dr.  Cameron 
hoped  the  discussion  would  be  narrowed  down 
to  the  two  following  questions:  (i)  Are  drugs 
of  any  value,  do  they  'lielp  us  in  the  manage- 
ment of  the  third  stage  of  labor  ;  if  so,  what  are 
they  ?  What  are  their  indications  and  contra- 
indications? (2)  Are  manipulations  of  service  ; 
if  so,  what  manipulations  and  when  are  they  of 
use  ?  What  are  their  indications  and  their  con- 
tra-indications  ? 

Dr.  H.  L.  Reddv  then  took  up  the  drugs 
used  in  the  third  stage  of  labor  ;  his  paper  on 
the  subject  was  as  follows  : — 

The  part  assigned  to  me  in  to-night's  discus- 
sion is  the  use  of  drugs,  or  rather  the  drugs 
used,  in  the  third  stage  of  labor. 

I  find  liiat  it  is  impossible  to  limit  myself  to 
the  third  stage  in  some  cases  ;  as,  for  example, 
chloroform,  which  is  so  commonly  used  in  the 
second  stage,  and   so  frequently  produces  un- 


THE   CANADA    MEDICAL   RECORD. 


149 


pleasant  effects  in  the  third.  Therefore,  I  hope 
you  will  pardon  me  if  I  take  up  your  time,  to 
some  extent,  in  considering  these  drugs  outside 
the  stage  under  discussion. 

I  have  endeavored  to  give  the  opinions  of 
standard  autliorities,  and  have  also  taken  the 
trouble  to  write  to  a  number  of  the  leaiiing 
obstetricians  in  the  United  States,  more  par- 
ticularly with  regard  to  the  use  of  ergot  and 
chloroform,  and  have  received  replies  to  all  of 
my  enquiries.  This,  I  think,  will  perhaps  make 
what  I  have  to  say  slightly  more  interesting. 

The  time  allotted  to  me  is,  I  am  sorry  to  say, 
entirely  too  short  to  give  more  than  a  short 
resume  of  the  subject.  I,  therefore,  have  oiily 
taken  up  for  consideration  the  most  commonly 
used  drugs. 

AN.ESTHETICS. 

Firstly,  what  is  the  indication  for  them  ? 
Relief  of  pain  ; 
Relaxation  of  parts  ; 
Prevention  of  untimely  movements. 

In  looking  up  the  matter  we  find  Donhoff,  in 
the  Archives  for  Gynaecology,  shows  the  in- 
fluence of  chloroform  upon  the  course  of  nor- 
mal labor  by  the  tachadynamometer  to  be  as 
follows : 

The  administration  of  chloroform,  even  in 
diminutive  doses,  exercises  a  retarding  influence 
upon  the  progress  of  labor.  Time  prevents 
us  taking  up  his  experiments  fully. 

Playfair,  the  English  standard  authority, 
says  : 

"The  tendency  of  the  present  day  is  to  give 
too  much  anffislhetic  during  child-birth,  and  a 
common  error  is  the  administration  of  chloro- 
form to  an  extent  which  materially  interferes 
with  uterine  contractions,  and  predisposes  to 
postpartum  haemorrhage.     In  considering  an- 
aesthesia in  the  third  stage,  or  the  effects  pro- 
duced in  the  third  stage,  the  subject  would  not 
be  complete  without  referring  to  its   use  in  the 
earlier   stage    of    labor.     Generally   speaking, 
we  do  not  think  of  giving  chloroform  until  the 
OS  is  fully  dilated,  the  head  descending,  and  the 
pains  becoming  propulsive.     It  has  often  been 
administered    earlier,  in  order    to   aid   in    the 
dilatation  of  a  rigid  cervix,  and  while  it  mxy 
succeed    well,    chloral    answers    the    purpose 
better.     There  is  one  cardinal   rule  to  be  ob- 
served:  in  giving    chloroform  during  the  pro- 
pulsive stage,  it  should  be  administered  inter- 
mittently  and   not   continuously.     When    the 
pain  comes  on,  a  few  drops  may  be  scattered 
over  a  Skinner's  inhaler.     During  the  acme  of 
the  pain  the  patient  inhales  it  freely,   and  at 
once  experiences  a  sense  of  great  relief.     As 
soon  as  the  pain  dies  away  the  inhaler  should  be 
removed.     Indeed,  if  properly  given,  conscious- 
ness should  not  be  entirely  abolished,  and  the 

patient  between  the  pains  should  be  able   to 

speak  and  understand  what  is  said   to  her,  or, 


in  other  words,  the  chloroform  should  be 
administered  to  the  obstetric  and  not  to  the 
surgical  or  profound  insensibility,  except,  per- 
haps, just  at  the  moment  the  head  is  passing 
over  the  perineum.  The  effect  of  the  chloro- 
form on  the  pains  must  be  carefully  watched. 
If  they  become  materially  lessened  in  force  and 
frequency,  it  is  necessary  to  stop  the  inhalation 
for  a  short  time,  until  the  pains  get  stronger. 
This  effect  may  be  often  completely  and  easily 
prevented  by  using  Dr.  Sanson's  mixture,  one- 
"third  absolute  alcohol  and  two-thirds  chloro- 
form, this  diminishing  the  tendency  to  undue 
relaxation.  Bearing  in  mind  the  tendency  of 
chloroform  to  produce  uterine  relaxation,  more 
than  ordinary  precautions  should  always  be 
taken  against  postpartum  haemorrhage,  in  all 
cases  in  which  it  has  freely  been  administered. 
In  cases  of  operative  midwifery,  it  is  usually 
given  to  the  extent  of  complete  anaesthesia,  and 
in  all  such  cases  it  should  be  given  by  another 
medical  man,  not  by  the  operator." 

Winkel  believes  that  chloroform  should  not 
be  used  in  all  obstetrical  operations,  unless 
they  are  of  a  difficult  nature,  and  believes  the 
best  method  even  here  in  order  to  avoid  diffi- 
culties is  to  carry  the  anaesthesia  only  so  far 
that  the  patient  feels  the  pains  at  the  comple- 
tion of  the  operation  and  awakens  with  the 
crying  of  the  child. 

Dr.  E.  Montgomery,  Philadelphia,  makes  it 
a  rule  to  give  an  anaesthetic  to  every  patient 
during  the  second  stage  of  labor.  The 
anaesthetic  he  uses  is  the  bromide  of  methyl, 
which  has  the  advantage  over  ether  and  chloro- 
form that  it  acts  quickly  and  its  effects  pass  off 
quickly,  thus  producing  less  influence  than 
either  ether  or  chloroform.  It  is  not  necessary 
that  the  patient  should  be  brought  so  profoundly 
under  its  influence  as  is  necessary  under  chloro 
form.  He  says:  "I  have  never  found  it  to 
have  any  unpleasant  influence  upon  the  third 
stage  of  labor,  as  is  claimed  to  arise  from  the 
use  of  chloroform." 

Dr.  Parvin  uses  anaesthetics  possibly  in  one- 
third  of  his  cases,  usually  ether.  He  finds  that 
it  blunts  the  sharp  edge  of  the  pain,  the  patient 
bears  down  better,  and  it  lessens  the  resistance 
of  the  soft  parts.  He  believes  that  it  neither 
induces  haemorrhage  nor  delays  uterine  contrac- 
tion if  given  in  moderate  quantities,  so  as  only 
to  produce  obstetrical,  not  surgical,  anaesihesia. 
For  prolonged  operations  he  uses  ether  always. 
Dr.  H.  J.  Garriges,  of  New  York,  uses 
anaesthetics  in  every  case  in  the  second  stage 
of  labor,  unless  the  patient  objects, — generally 
chloroform.  He  considers  that  it  is  apt  to  invite 
want  of  contraction  and  hemorrhage.  He  con- 
siders ether  safer  if  tne  kidneys,  lungs  and  brain 
are  healthy. 

Dr.  \Vm.  Polk  does  not  use  anaesthetics  if  he 

cm  evade  it,  and    then  only  at   the  close    of 

1  labor,  never  in  pathological    cases.     He  con- 


ISO 


THE   CANADA   MEDICAL   RECORD. 


siders,  outside  of  the  relief  of  pain,  tlie  effect  is 
a  bad  one,  as  it  both  induces  hemorrhage  and 
delays  uterine  contraction  in  the  third  stage. 

Dr.  E.  H.  Grandin  as  a  rule  uses  an  anaes- 
thetic when  the  presenting  part  reaches  the 
pelvic  floor,  always  in  primiparae.  He  uses 
chloroform,  except  in  cardiac  cases,  and  then 
ether.  He  finds  that  it  produces  relaxation  of 
uterine  spasms  and  of  spasm  of  the  muscles 
and  fascia  of  the  pelvic  diaphragm.  "If  the 
anaesthesia  be  prolonged,"  he  says,  "  I  am  on 
the  lookout  for  excessive  haemorrhage  and  de- 
layed uterine  contraction."  He  uses  chloro 
form  in  prolonged  operations  when  a  careful 
anaesthetist  gives  it,  otherwise  he  uses  ether. 

Dr.  Reynolds  uses  anaesthetics  in  the  second 
stage  of  labor  when  the  contractions  are  good. 
He  finds  the  action  to  be  relaxation  of  the  os 
and  the  muscles  of  the  perineum,  with  diminu- 
tion of  the  force  of  labor,  in  slow  cases  this 
latter  being  one  of  the  disadvantages  of  the  use 
of  the  drug.  He  says  he  generally  carries 
ether  to  the  point  of  unconsciousness  so  soon 
as  he  can  control  the  chin  per  rectum,  in  the 
belief  that  he  can  more  often  by  this  method 
save  the  perineum.  He  believes  that  the  use 
of  an  anaesthetic  in  the  second  stnge  causes  an 
increase  in  the  relaxation  of  the  uterus  and 
consequent  haemorrhage.  He  has  never  had  a 
fatal  case  of  post-partum  haen.orrhage.  He  uses 
ether  entirely,  because  the  opinion  of  the  com- 
munity in  which  he  lives  is  against  the  use  of 
chloroform. 

Dr.  Clifton  Edgar  does  not  use  anaesthetics 
as  routine  in  tiie  second  stage  of  labor.  When 
he  does  use  an  anaesthetic  he  uses  the  A.  C.  E. 
mixture,  sometimes  sulphuric  ether.  He  finds 
that  it  relaxes  a  rigid  cervix,  often  rendering 
the  subsequent  pains  more  efficient.  Chloro- 
form, he  finds,  is  likely  to  produce  both  haemor- 
rhage and  delay  in  uterine  contraction  when 
used  in  excess.  In  prolonged  operations  he 
uses  ether,  and  his  chief  objection  to  chloro- 
form is  that  one  not  tlioroughly  familiar  with 
its  administration  will  abuse  its  use  by  giving 
too  much. 

Dr.  Charles  M.  Green  almost  always  uses 
anaesthetics  in  the  second  stage  of  labor  and 
uses  Squib's  sulphuric  ether.  He  finds  the 
effect  produced  to  be  a  relaxation  of  the  soft 
parts,  better  success  in  saving  the  perineum 
from  laceration,  both  on  account  of  relaxation 
and  because  he  has  complete  control  of  the 
patient.  Personally  he  has  had  no  bad  effects, 
but  believes  that  long  continued  anaesthesia 
does  predispose  to  uterine  inertia  and  haemor- 
rhage. In  i^rolonged  operations  he  states  that 
all  the  Boston  men  use  eiher  to  the  exclusion 
of  chloroform,  iiis  chief  objection  to  chloroform 
being  that  it  is  more  dangerous  to  administer. 

Dr.  E.  P.  Davis  uses  anaesthesia  in  nine  cases 
out  of  ten,  usually  chloroform  for  normal  cases 
and  version,  for  all  the  other  operations  ether. 


He  finds  that  it  produces  better  uterine  con- 
traction by  removing  the  cerebral  inhibition 
from  conscious  suffering,  partial  relaxation  of 
the  uterus  when  pushed,  facilitating  manipu- 
lation. He  believes  that  chloroform  when 
properly  used  produces  neither  haemorrhage 
nor  delayed  uterine  contractions  in  the  third 
stage. 

It  is  generally  agreed  that  the  operator  must 
always  begin  the  anaesthesia  if  no  skilled  assist- 
ant is  present.  After  anaesthesia  has  been 
begun,  the  nurse  may  hold  the  inhaler,  although 
the  physician  must  himself  pour  on  the  fresh 
chloroform  if  needed.  For  the  want  of  follow- 
ing this  rule  I  have  known  of  a  fatal  case  hap- 
pening. In  chloroform  narcosis  the  contra- 
indications are  cases  of  anaemia  in  the  dying, 
well-marked  goitre,  in  myocarditis,  in  cases  of 
dyspnoea  or  extreme  collapse,  heart  disease,  or 
placenta  i)rc'evia. 

To  sum  up,  with  regard  to  anaesthetic?,  in 
this  country  and  the  United  States  the  majoiity 
of  practitioners  seem  rather  to  favor  its  use, 
although  in  England  and  abroad  they  do  not 
recommend  its  use  to  nearly  the  same  extent, 
and  almost  every  one  of  the  authorities  con- 
sulted agree  that  it  undoubtedly  predisposes  to 
uterine  inertia  and  consequent  haemorrhage  in 
tlie  third  stage.  This  more  particularly  applies 
to  chloroform,  which  is  mosl  commonly  used. 
Anaesthetics  are  hardly  ever  used  in  the  third 
stage,  unless  in  cases  of  severe  operative  pro- 
cedure. 

Dr.  J.  C.  Reeves,  of  Dayton,  Ohio,  one  of  the 
best  authorities  on  chloroform  in  the  United 
States,  and  author  of  the  chapter  on  the  subject 
in  the  A?ncrican  System  of  Obstetrics^  Vol.  I., 
uses  chloroform  frequently  whenever  the  pain 
is  severe  or  the  soft  parts  give  slowly.  He  says 
he  believes  that  it  has  an  injurious  effect  likely 
to  be  marked  in  proportion  to  the  length  of 
time  used  and  the  depth  of  narcotism.  He 
expects  to  watch  a  patient  more  closely  after 
anoesthetics. 

Dr.  George  L.  Engelmann,  of  St.  Louis,  uses 
anaesthetics  moderately  in  the  second  stage  of 
labor,  always  chloroform,  depending  upon  the 
sensitiveness  and  nervousness  of  the  pati-ent 
and  relation  of  the  pelvis  to  the  head.  He 
finds  the  effects  vary  with  the  case,  pains  more 
regular,  powerful  and  efficient  in  many  cases, 
especially  in  nervous  women.  He  believes  no 
ill  effects  arise  in  the  third  stage,  unless  over- 
done, and  care  is  necessary. 

Caseaux  finds  th,it  chloroform  is  of  service 
both  in  relieving  pain  and  causing  relaxation  of 
the  parts,  but  ])redisposes  in  the  third  stage  to 
uterine  inertia  and  p.p.  haemorrhage. 

Such,  I  may  say,  is  my  personal  experience 
both  in  private  and  ho5[)ital  work.  I  consider 
towards  the  end  of  the  second  stage,  where  the 
pain  is  very  severe,  it  is  apt  to  cause  inversion 
of    polarity,     thus    delaying    labor    and     con- 


I'riE  CANADA  MEDICAL   RECORD. 


i5i 


sequently  unnecessary  suffering,  therefore  an 
ansesthelic  should  be  given,  and  its  use  when 
the  head  is  stretching  tlie  perineum  will  very 
often  save  it  from  rupture.  But  to  give  it  beyond 
the  obstetrical  degree  and  for  long  periods  is 
not  only  unnecessary,  but  absolutely  bad 
practice. 

ERGOr. 

AVe  will  next  consider  ergot,  one  of  the  most 
common  drugs  used  in  the  third  stage. 

Play  fair  believes,  that  it  is  thoroughly  good 
practice  to  administer  a  full  dose  of  the  liquid 
extract  of  ergot  in  all  cases  after  the  placenta 
has  been  expelled,  to  insure  persistent  contrac- 
tion and  to  lessen  the  chance  of  blood  clots 
being  retained  in  utero.  He  prefers,  as  a  rule, 
personally  to  give  a  subcutaneous  injection  of 
ergotine  in  cases  where  there  is  a  history  in 
previous  labors  of  hemorrhage  after  the  birth 
of  the  child,  when  the  presentation  is  so  far 
advanced  that  we  estimate  that  the  labor  will 
be  concluded  in  from  ten  to  twenty  minutes,  as 
we  can  hardly  expect  the  drug  to  produce  any 
effect  in  less  time.  In  cases  of  post  partum 
hcemorrhage  the  dose  may  be  repeated,  but  here 
the  hypodermic  use  of  ergotine  offers  the 
double  advantage  of  acting  with  greater  power 
and  much  more  rapidly  than  the  usual  method 
of  administration.  It  should  therefore  be 
always  used  in  preference. 

Chahbazain,  of  Paris,  recommends  an  aque- 
ous solution  of  ergotine  the  one  two-hundredth 
of  a  grain  in  ten  minims  of  water  as  acting 
more  energetically. 

Dr.  Engelmann,of  St.  Louis,  says  in  obstetric 
practice  it  does  good  service  if  given  after  the 
conients  of  the  uterus  have  been  expelled,  to 
stimulate  contraction  when  labor  is  completed, 
and  as  a  safeguard,  especially  after  the  physi- 
cian has  left  his  patient. 

Dr.  J.  C.  Reeves,  of  Dayton,  Ohio,  does  not 
use  ergot  as  routine  practice,  but  when  he  does 
give  it,  it  is  only  after  the  expulsion  of  the  child, 
in  doses  of  one  fluid  drachm.  He  finds  that 
irregular  contraction  of  the  uterus  is  caused, 
imprisoning  the  placenta  very  frequently  after 
its  administration. 

Dr.  Norris,  of  Pennsylvania,  recommends  in 
every  case  the  administering  of  one  drachm  of 
fluid  extract  of  ergot  in  the  treatment  of  the 
third  stage. 

Dr.  H.  Grandin,  of  New  York,  uses  ergot  as 
routine  practice  in  obstetrics,  after  the  uterus 
has  been  thoroughly  emptied,  an.i  finds  that  its 
routine  use  prevents  undue  relaxation  and 
appears  to  promote  proper  involution.  He 
uses  a  half  to  one  drachm  of  fluid  extract  of 
ergot  for  three  days,  and  then  twenty  drops 
three  limes  a  day  for  a  week. 

Dr.  Wm.  M.  Polk,  of  New  York,  does  not 
use  it  as  routine,  but  when  he  does  give  it,  it  is 
always  after  the  second  stage  of  labor,  and   he 


He 


finds  that  it  produces  uterine  contraction, 
uses  one  drachm  of  the  fluid  extract. 

Dr.  Edward  Reynolds,  of  Boston,  uses  ergot 
as  routine  practice,  never  before  the  delivery 
of  the  placenta,  and  finds  that  it  hastens  the 
occurrence  of  tonic  contractions,  and  thus 
lessens  the  likelihood  of  post  partum  haemor- 
rhage. He  uses  the  fluid  extract.  Squib's,  one 
drachm. 

Porro  recommends  ergot  in  cases  of  haemor- 
rhage, or  where  ha^morrliage  is  likely  to  occur. 
Dr.  Marx,  of  New  York,  in  large  hospital 
experience,  has  in  nearly  every  case  given  ergot 
by  mouth,  at  or  toward  the  end  of  the  second 
stage  of  labor,  and  has  never  seen  a  bad  result 
fron'  its  use,  certainly  never  a  case  of  accidental 
haemorrhage.  He  finds  that  there  is  no  better 
remedy  to  regulate  the  pains  of  labor  than 
ergot.  Possibly  large  dosesof  quinine,  but  tiiis 
remedy  does  not  increase  the  frequency  of 
pains  as  much  as  it  increases  their  vigor.  It 
IS  impossible  to  wait  for  the  administration  of 
ergot  until  the  uterus  is  absolutely  empty,  for 
then  it  would  never  be  given,  as  there  are  always 
shreds  of  decidua  and  blood. 

Dr.  Nash,  of  Washington,  does  not  approve 
of  the  administration  of  ergot  after  the  placenta 
has  been  delivered,  or  that  of  promoting  the 
process  of  involution  by  the  daily  display  of 
ergot,  digitalis  and  quinine,  as  is  suggested  in 
practice  in  some  institutions, 

Reynolds,  in  his  work  on  midwifery,  declares 
the  efficiency  of  ergot  in  producing  tonic  retrac- 
tion of  the  recently  delivered  uterus  is  un- 
doubted, and  since  its  use  is  productive  of  no 
possible  harm,  it  is  the  usual  custom,  and  the 
author  believes  should  be  the  habit,  of  all  ooste- 
tricians,  to  administer  to  the  patient  a  teaspoon- 
ful  of  the  extract  immediately  after  the  birth  of 
the  placenta.  This  is  to  be  recommended  as 
a  routine  procedure,  because  the  action  of  ergot 
is  too  slow  to  render  it  of  value  if  its  adminis- 
tration is  delayed  until  after  the  occurrence  of 
hasmorrhage,  unless  it  is  given  hypodermically, 
a  procedure  which  it  is  wise  to  avoid,  in  view 
of  the  fact  that  the  hypodermic  use  of  ergot  is 
not  unfrequently  followed  by  subcutaneous 
abscess.  If  it  is  so  used,  it  should  be  deeply 
injected  into  the  substance  of  the  thigh,  as  this 
method  decidedly  diminishes  the  risk  of  sub- 
sequent suppuration.  The  use  of  ergot  by  the 
mouth  is  occasionally  followed  by  nausea, 
which  is,  however,  rare,  if  no  more  than  a 
drachm  of  the  fluid  extract  is  given  in  about 
two  ounces  of  cold  water. 

Dr.  Clifton  Edgar  does  not  use  ergot  as  rou- 
tine practice,  but  if  given,  always  after  the 
third  stage.  He  finds  it  produces  good  uterine 
contractions,  and  possibly  the  prevention  of 
after-pains.  He  gives  one  drachm  of  fluid 
extract  at  a  dose. 

Dr.  Charles  M.  Green,  of  Boston,  uses  ergot 
as  routine  practice,  after  the  delivery    of  the 


152 


THE   CANADA   MEDICAL   RECORD. 


placenta,  never  before,  and  finds  that  it  pro- 
motes the  contraction  and  retraction  of  the 
uterus  and  thus  helps  to  prevent  haemorrhage. 
He  generally  uses  a  drachm  of  the  fluid  extract 
at  a  dose.  He  considers  that  grasping  the 
fundus  after  the  use  of  ergot  causes  a  succes- 
sion of  rhythmical  contractions  and  consequent 
retraction,  which  latter  action  permanently 
closes  the  uterine  sinuses. 

Dr.  E.  P.  Davis,  of  Philadelphia,  does  not 
use  ergot  as  routine  practice,  but  only  when  the 
uterus  fails  to  properly  contract  and  remain 
contracted.  He  finds  the  effect  produced  to  be 
that  it  promotes  uterine  contraction  and  fur- 
thers involution,  and  when  given  in  small  doses 
after  the  third  stage  it  increases  blood  pressure 
in  the  breast  and  furthers  the  secretion  of  milk. 
He  uses  the  fluid  extract  in  doses  of  from  one 
drachm  to  ten  minims. 

Dr.  Parvin,  of  Philadelphia,  does  not  use 
ergot  as  routine  practice  in  obstetrics.  He 
occasionally  gives  it  in  the  second  stage  of 
labor  in  small  doses  when  the  contractions  are 
weak.  After  the  delivery  of  the  placenta,  if  the 
uterus  fails  to  contract  sufficiently,  he  gives 
from  half  to  a  teaspoonful  of  the  fluid  extract  to 
provide  against  haemorrhage.  He  finds  that 
there  is  an  increase  of  force  in  intermittent  con- 
tractions from  small  doses,  continuous  action 
from  large.  In  some  cases  he  finds  no  bene- 
ficial results  at  all. 

According  to  Wernich,  ergotine  lessens  the 
tension  of  the  veins  and  increases  their  dilata- 
tion. This  produces  arterial  anaemia  of  the 
uterus  and  its  nerve  centres,  which  increases 
the  duration  and  intensity  of  its  contraction  ; 
after  strong  doses  the  intervals  cease  altogether 
and  a  condition  very  like  tetanus  uteri  sets  in. 

According  to  Kobert,  this  action  is  due  to 
sphaoelic  acid  contained  in  ergot,  while  the 
ergotinic  acid  has  no  effect  on  the  uterus  whether 
gravid  or  not.  The  third  constituent  part  of 
ergot,  cornutin,  a  pure  alkaloid,  was,  according 
to  Grafe's  and  Erhard's  experiments,  given 
repeatedly  in  the  first  stage  of  labor  in  doses 
of  5  mg.,  and  in  nearly  two-thirds  of  the  cases 
'  improved  the  pain  and  did  the  mother  no  harm. 

Schatz  declares  that  the  action  of  ergot  begins 
fifteen  minutes  after  its  administration  by  the 
mouth,  is  greatest  in  thirty  minutes,  and  the 
effects  of  a  single  dose  last  for  an  liour. 

Winkel  says  its  use  in  placenta  pra^via,  before 
and  during  labor,  is  still  sub  judice.  Auvard 
used  it  with  unsatisfactory  results,  mortality 
bein;4  42  per  cent,  of  the  mothers  and  77  per 
cent,  of  the  children.  On  the  other  hand, 
Wilson  had  a  mortality  of  6.6  per  cent,  of  the 
mothers  and  26.6  per  cent,  of  the  children,  using 
it  before  labor. 

Counter- indications,  I  know  of  none,  unless 
it  be  its  administration  during  the  progress  of 
the  first  and  second  stages  of  labor,  or  in  cases 
of  known  idiosyncrasy,  where  it  causes  severe 


and  exceedirgly  painful  tonic  contractions, 
amounting  almost  to  tetanus  uteri. 

Caseaux  recommends  ergot  for  use  in  the 
ihird  stage,  as  causing  firm  uterine  contraction, 
promoting  involution"  and  tending  to  prevent 
haemorrhage. 

To  sum  up  with  regard  to  ergot,  it  is  used  by 
the  great  majority  of  practitioners,  as  well  as 
recommended  by  the  standard  authors  at  home 
and  abroad.  They  nearly  all  agree  that  it 
undoubtedly  produces  firm  contraction  of  the 
uterus  at  the  completion  of  the  third  stage,  if 
given  in  doses  of  one  fluid  drachm,  grasping 
the  fundus,  assisting  in  keeping  up  not  only  the 
contraction  but  the  polarity  of  the  uterus,  and 
inasmuch  as  it  takes  15  to  20  minutes  to  act,  it 
had  better  be  given  immediately  on  the  com- 
pletion of  the  second  stage.  None  of  them 
speak  of  any  bad  effects  resulting  from  its  use, 
and  I  fail  to  see  why  any  sensible  practitioner 
should  refuse  or  object  to  its  use.  My  own 
practice  certainly  is,  both  in  private  and  in 
the  hospital,  to  give  one  fluid  drachm  at  the 
conclusion  of  the  second  stage,  and  in  the 
hospital  I  give  for  the  following  week  ten  drops 
of  the  fluid  extract  three  times  a  day,  combined 
with  both  digitalis  and  quinine.  This  latter,  I 
believe,  both  tends  to  close  the  sinuses  and 
regions  from  which  infection  might  occur,  and 
to  promote  involution  as  well  as  slightly  to 
increase  the  blood  pressure.  The  latter  I  con- 
sider to  be  a  distinct  advantage. 

STYPTICS. 

Dr.  Playfair  States  that  in  severe  cases  where 
the  uterus  obstinately  refuses  to  contract  in 
spite  of  all  our  efforts — and  do  what  we  may, 
cases  of  this  kind  will  occur — the  only  other 
agent  at  our  command  is  the  application  of  a 
powerful  styptic  to  the  bleeding  surface  to 
produce  thrombosis  of  the  vessels.  The  latter, 
says  Dr.  Ferguson  in  his  preface  to  Gooch  on 
Diseases  of  Women,  appears  to  be  the  sole  means 
of  safety  in  those  cases  of  intense  flooding  in 
which  the  uterus  flaps  about  in  the  hand  like 
a  wet  towel.  Incapable  of  contraction  for  hours, 
yet  ceasing  to  ooze  out  a  drop  of  blood,  there 
is  nothing  apparently  between  life  and  death 
but  a  few  soft  coagula  plugging  up  the  sinuses. 
These  form  but  a  frail  barrier  indeed,  but  the 
experience  of  all  who  iiave  used  the  injection  of 
a  solution  of  perchloride  of  iron  in  such  cases 
proves  that  it  is  thoroughly  effectual,  and 
its  introduction  into  practice  is  one  of  the 
greatest  improvements  in  modern  midwifery. 
The  dangers  of  the  practice  have  been  strongly 
insisted  on,  but  there  are  only  one  or  two  cases 
on  record  followed  by  any  evil  eftects.  Its 
.extraordinary  power  of  instantly  checking  the 
most  formidable  hcemorrhages  is  well  known  to 
all  who  iiave  tried  it.  Indeed,  Flayfair  goes  so 
far  as  to  say  that  no  practitioner  should  attend 
a  case  of  midwifery  without  having  his  styptic 


THE  CANADA  MEDICAL  RECORD. 


153 


with  him,  and  the  best  and  most  easily  obtain- 
able form  is  the  liquor  ferri  perchloridi  fortior 
of  the  B.P.,  and  should  be  u;;ed  diluted  with  six 
times  the  bulk  of  water.  It  is  important  that 
the  air  should  be  got  rid  of  out  of  the  syringe 
with  which  it  is  introduced  into  the  uterus,  and 
to  get  the  best  effect  the  uterus  should  be 
emptied  of  all  clots,  etc.,  before  its  use.  After 
its  use  for  some  days,  intra-uterine  injections 
should  be  used  to  remove  the  coagula  which 
are  certain  to  form,  and  thus  avoid  sajirpomia. 

VVinkel  says,  in  severe  cases  of  haemorrhage 
where  other  means  have  been  tried  and  failed, 
equal  parts  of  the  liquor  ferri  perchloridi  and 
water  may  be  slowly  injected  into  the  uterus 
with  good  effect,  or  it  may  be  applied  by  means 
of  a  sponge  or  piece  of  absorbent  cotton  to  the 
site  of  the  haemorrhage. 

Reynolds,  of  Boston,  recommends  that  in 
severe  cases  of  hsemorrhage,  Monsell's  solution 
or  liquor  ferri  persulphatis  diluted  with  four 
times  its  quantity  of  water  should  be  passed 
into  the  uterine  cavity  on  a  ball  of  absorbent 
cotton,  the  uterus  being  first  cleared  of  all 
clots. 

Dr.  Norris,  of  Pennsylvania,  considers  that 
styptic  salts  of  iron  are  dangerous,  as  the 
coagula  produced  by  them  may  extend  into  the 
vessels,  and  must  be  broken  up  by  putrefaction, 
exposing  the  patient  to  septic  poison. 

To  sum  up  with  regard  to  the  use  of  iron  in 
postpartum  haemorrhage,  several  of  the  standard 
authorities,  such  as  Playfair,  Winkel,  etc., 
recommend  its  use  as  being  the  only  remedy 
that  is  invariably  successful.  My  own  ex- 
perience has  been  most  favorable  to  the  use 
of  iron,  and  in  the  Women's  Hospital,  as  well 
as  in  private  practice,  the  invariable  rule  is  in 
all  cases  of  alarming  heemorrhage,  to  use  liquor 
ferri  perchloridi  diluted  with  from  six  to  ten 
times  its  bulk  of  water.  I  have  never  had  an 
accident  during  or  after  its  use  ;  the  results 
have  been  invariably  gratifying.  A  common 
objection  has  been  raised,  and  that  is  air  being 
injected  into  the  vessels.  I  fail  to  see  that  it  is 
any  more  likely  to  be  injected  with  the  iron 
solution  than  with  any  other  injection,  although 
one  could  perhajjs  understand  air  bemg  im- 
prisoned in  clots,  but  this  perhaps  is  far  fetched 
and  harmless.  I  think  the  chief  danger,  if  not 
the  only  one,  that  is  the  clots  which  form  in  the 
uterus  are  firm  and  do  not  easily  come  away, 
and  are  apt  to  set  up  sapraemia,  unless  they  are 
washed  away  by  intra  uterine  douches  given  at 
least  twice  daily.  Another  danger  might  perhaps 
be  if  the  erdof  the  nozzle  were  applied  directly 
to  a  sinus,  the  solution  might  be  pumped  directly 
into  the  circulation.  I  can  find  a  record  of  but 
three  fatal  cases  from  its  use,  two  mentioned  by 
Playfair  and  one  witnessed  by  Dr.  J.  C.  Cameron 
at  the  Rotunda,  Dublin. 

Noeggerath  recommends  tincture  of  iodine, 
I  to  5  of  water. 


Dupierries  30  water,  15  tincture  of  iodine, 
potassium  iodide  5.  These  do  not  seem  to  be 
greatly  used,  though  they  doubtless  act  as 
styi:)tics. 

Reynolds  refers  to  tincture  of  iodine  being 
used  preferably  to  Churchill's,  and  states  the 
advantage  of  iodine  over  the  iron  Foluiion  is 
its  more  stimulating  character,  and  the  lesstr 
liability  of  causing  an  extensive  thrombosis 
formation  and  a  consequently  increased  danger 
of  septic  infection. 

Penrose  strongly  recommends  strong  vinegar, 
which  has  the  advantage  of  being  always  readily 
obtainable.  He  speaks  highly  of  its  hoiinostatic 
effect.  He  soaks  a  clean  handkerchief  in  it  and 
introduces  it  by  the  hand  into  the  uterine  cavity, 
an:l  squeezes  it  over  the  endometrium.  He 
says  the  effect  of  the  vinegar  flowing  over  the 
sides  of  the  cavity  of  the  uterus  and  vagina  is 
magical.  The  relaxed  and  flabby  uterine  muicle 
instantly  responds,  the  organ  assumes  what  is 
called  its  gizzard-like  feel,  shrinking  down  upon 
and  compressing  the  operating  hand,  and  in  the 
vast  majority  of  cases  the  haemorrhage  ceases 
instantly. 

Playfair  remarks  that  it  might  be  worth  trying 
before  using  the  iron  solution. 

Reynolds  advises  a  i  to  jog  hot  water  solu- 
tion of  the  ofticinal  acetic  acid  as  a  prompt 
styptic. 

Creolin  if  added,  even  in  the  quantity  of  a 
few  drops,  to  the  hot  water  injections  used  in 
post-partum  haemorrhage,  acts  as  a  powerful 
styptic  as  well  as  a  good  antiseptic  ;  or  carbolic 
acid  may  be  added  to  the  hot  douche  about  the 
strength  of  i  to  40  or  80,  and  would  be  found  to 
act  as  a  haemostatic  by  its  stimulating  contrac- 
tion of  the  uterus. 

DISINFECTANTS. 

The  use  of  disinfectants  in  the  third  stage  is 
at  present  a  vexed  question,  and  the  use  of 
douching  either  before  labor  or  after  labor, 
unless  for  cause  such  as  a  severe  leucorrhoea  or 
one  that  is  suspected  of  being  infected  by 
gonococci,  is  at  present  rather  condemned  than 
advised.  In  one  of  last  numbers  of  the  Archives 
for  Gyncecolo^y  are  statistics  very  unfavorable 
to  it.  Probably  the  most  commonly  used  dis- 
infectant is  corrosive  sublimate. 

Winkel  says  the  use  of  corrosive  sublimate 
for  irrigating  the  uterus  is  to  be  avoided,  as 
poisoning  is  liable  to  supervene ;  but  if  used,  a 
I  to  5000th  corrosive  sublimate  solution  at  a 
temperature  of  about  no  to  115°  F.,  that  is,  at 
that  which  is  distinctly  but  not  uncomfortably 
hot  for  the  hand. 

Playfair  says  that  a  solution  of  i  in  2000th 
solution  of  perchloride  of  mercury  may  be  used, 
if  needed,  to  diminish  the  danger  of  sapraemia. 

Reynolds  recommends  a  i  to  5oooih  corro- 
sive sublimate  solution  at  a  temperature  of  no 
to  115°  F. 


t54 


tHE   CANADA   MEDICAL   RECORD. 


Dr.  Howard  Kelly  writes  :  "  The  best  disin- 
fectant in  puerptral  cases  is  pure  warm  water. 
The  trouble  of  all  drugs  applied  intra-uterine  is 
that  they  only  reach  the  less  superficial  area, 
and  if  there  are  any  focci  of  infection,  the  germs 
which  lie  deep  in  the  tissues  are  neither  de- 
stroyed nor  removed.  For  this  reason  I  con- 
sider the  mechanical  means,  with  pure  and  free 
drainage,  the  be^t.  The  bichloride  of  mercury 
I  consider  dangerous  and  inefficient,  and  ought 
never  to  be  used  under  any  circumstances 
intra-uterine." 

Dr.  Norris,  of  Pennsylvania,  says  tiie  bich- 
loride of  mercury  is  effective  but  dangerous. 
Creolin  is  as  powerful  and  safer,  and  is  there- 
fore to  be  recommended. 

My  own  experience  of  the  use  of  corrosive 
sublimate  post-partum,  in  similar  and  even 
weaker  solutions,  is  most  unfavorable,  although 
followed  by  large  douches  of  warm  water,  which 
but  few  authors  recommend  to  be  used.  In 
a  solution  strong  enough  to  be  of  service,  most 
authors  agree  it  is  dangerous  to  use  intra-uterine, 
and  it  ranks  no  higher  in  the  comparative  table 
than  does  creolin  and  probably  strong  solution 
of  permanganate  of  potash.  'I'herefore  it  ought 
to  be  discarded,  except  for  external  use. 

Ice  and  iced  water  are  lecommended  by 
many  autliors  to  be  used  in  ca.-^es  of  p.p.  haemor- 
rhage, the  ice  introduced  to  be  not  larger  than 
a  walnut.  There  are  several  objections,  I  think, 
to  its  use:  it  increases  the  shock  already 
existing,  although  it  undouNtediy  checks  tiie 
hzemorrhage  for  the  lime  being,  and  as  soon  as 
it  melts  or  is  removed,  the  haemorrhage  often 
returns  as  severely  as  before,  the  uterine  vessels 
which  it  contracted  now  dilating.  Gieai  care 
would  also  have  to  be  used  that  no  sharp, 
irregular  pieces  were  introduced,  as  the  con- 
traction product  d  by  the  ice  might  possibly 
drive  the  sharp  points  through  the  uterus.  In 
winter  in  this  country  some  practitioners  make 
a  hard  snowball  and  introduce  it,  thus  avoiding 
the  danger  of  perforation. 

Hot  water  is  probably  the  most  commonly 
used  and  be>t  means  for  checking  p.p.  hemor- 
rhage at  a  temperature  of  from  i  lo*^  to  128.75° 
F..  this  latter  temperature  being,  in  my  opinion, 
much  too  warm,  being  decidedly  uncomfortable 
to  the  hand.  The  water  should  have  been 
boiled  and  been  allowed  to  cof)l.  It  has  the 
advantage  of  being  ahvay  s  obtainable,  of,  as  a 
rule,  slopping  the  hxmorrliage,  and  of  allowing 
afterwards  some  other  means  to  be  used  if 
desired.  The  quantity  to  be  used  should  be  at 
least  from  one  quart  to  half  a  gallon,  and  if 
given  by  a  douche  bag  held  sufficiently  high, 
at  least  six  or  seven  feet,  will  not  only  check 
haemorrhage,  but  also  remove  the  debris  from 
the  uterus.  One  point  about  giving  the  hot 
douche  is  that  a  metallic  nozzle  should  never 
be  used,  preferably  a  perfectly  aseptic  German 
glass  tube. 


The  question  may  be  asked  :  what  would  you 
consider  a  dangerous  hemorrhage?  This  is 
only  a  relative  term,  for  what  to  one  would  be 
but  a  slight  hemorrhage  might  to  another,  or  to 
the  same  under  certain  conditions,  be  a  danger- 
ous hemorrhage.  Generally  speaking,  a  slight 
hemorrhage  would  be  from  ^oo  to  j,ooo  gms. 
of  blood  lost,  a  profuse  hemorrhage  from  1,000 
to  1,500  gms.,  and  a  dangerous  from  1,500  to 
2,000  gms. 

STIMULANTS. 

Amongst  the  stimulants  used  in  p.p.  hemor- 
rhage, probably  none  will  be  f')und  to  act  more 
promptly  or  satisfactorily  than  the  nitrate  of 
strychnia,  in  doses  of  from  one-fortieth  to  one- 
twentieth  of  a  grain  hypodermically,  within  a 
very  short  period  the  pulse  rate  becoming  much 
slower  and  fuller. 

Opium  in  cases  of  hemorrhage  is  highly 
recommended  by  many  of  the  authors,  and  seems 
to  have  a  direct  action  as  a  stimulant  upon  the 
heart.  It  is  best  given  in  the  form  of  a  hypo- 
dennic  of  Batiley. 

Brandy  or  ether  are  used  hypodermically. 
either  after  severe  hemorrhage  with  heart 
failure,  or  heart  failure  from  any  cause  in  ihe 
third  stage  or  immediately  after  it.  It  is  given 
hypodermically  in  half  drachm  doses,  repeated 
as  often  as  needed.  Most  authorities  recom- 
mend its  use. 

A  solution  of  chloride  of  sodium,  although 
seldom  used  directly  in  the  third  stage,  may  be 
needed,  and  is  a  most  excellent  remedy  imme- 
diately after  severe  cases  of  hemorrhage, 
whether  post-partum  or  in  cases  of  p'acenta 
previa  Its  use  is  found  in  supplying  fluid  to 
the  arterial  system  depleted  by  the  hemorrhage, 
and  perhaps  preventing  too  great  absorption  of 
noxious  fluids.  It  may  be  be?t  adminisierc-d  in 
the  strength  of  a  dessertspoonful  and  a  half 
to  a  quart  of  tepid  water,  and  allowed  to  trickle 
into  the  rectum  from  the  douche  bag  placed  at 
about  the  level  of  the  anus,  the  attendant  every 
half  hour  lifting  the  bag  and  allowing  a  small 
quantity  to  enter.  As  much  as  a  gallon  and  a 
half  may  thus  be  given  and  absorbed  in  thirty- 
six  hours,  the  effect  on  the  pulse  being  most 
gratifying,  being  not  so  com|)ressiblc  and  much 
more  full.  The  advantage  of  the  solution  ot 
sodium  is  that  it  is  readily  absorbed  by  the 
rectum. 

In  conclusion,  1  beg  to  thank  you,  gentlemen, 
for  the  patience  with  which  you  have  listened  to 
me.  The  brief  which  I  have  held  for  tiie  use 
of  drugs  in  the  third  stage  I  h  ive  endeavored 
to  defend,  and  I  hope  to  convince  any  sceptics, 
if  it  be  possible  there  are  si:ch,  that  drugs  are 
not  only  useful,  but  on  occasions  absolutely 
required,  and  anyone  not  using  them  places 
himself  against  the  weight  of  authority  in  the 
medical  world. 

Dr.  A.   A.    Browne  took  up  the  manipula- 


THE  CANADA   MEDICAL   RECORD. 


155 


live  processes  which  nrght  be  lequired  in 
management  of  the  third  stage.  These  were  : 
(i)  Manual  expression  of  the  placenta  by  the 
hand  externally,  and  (2)  removal  of  retained 
placenta  by  the  hand  in  iitero.  He  thought 
that  after  the  child  was  born  and  the  cord  tied, 
gentle  pressure  should  be  made,  the  uterus 
followed  down  as  it  contracted,  while  the 
patient  was  allowed  to  rest  and  the  placenta  to 
become  separated.  In  an  absolutely  normal 
labor  the  uterus  would  expel  the  placenta  with- 
out further  assistance  in  from  15  to  20 
minutes;  if  it  did  not,  expression  was  done 
probably  best  by  the  method  of  Crede.  1  his 
is  carried  out  in  the  following  manner:  The 
uterus  should  be  grasped  in  the  hollow  of  the 
left  hand,  the  ulnar  edge  being  well  pressed 
down  behind  the  fundus,  and  when  it  was  felt 
to  harden,  strong  and  firm  pressure  should  be 
made  downward  and  backwards  in  the  axis  of 
the  pelvic  brim.  If  the  first  attempt  were 
unsuccessful,  the  manoeuvre  should  be  repeated 
at  the  next  contraction,  and  on  a  second  fail- 
ure a  vaginal  examination  made,  and  the  pla- 
centa, if  found  lying  wholly  in  the  vagina, 
withdrawn.  If,  however,  it  were  still  in  the 
uterine  cavity,  he  would  again  attempt  to  expel 
it  by  pressure  and  not  by  traction  on  the  cord. 
The  membranes  were  best  removed  by  twist- 
ing and  gentle  traction. 

Dr.  Browne  divided  retained  placenta  into 
two  kinds  :  (i)  Simple  and  (2)  where  due  to 
morbid  adhesions.  The  former  might  be 
caused  by  inertia,  large  size  of  the  placenta, 
hour-glass  contraction,  traction  on  the  cord,  or 
ergot.  The  latter  was  due  to  endometritis 
before  or  metritis  or  placentitis  during  preg- 
nancy. 

He  recommended  introducing  the  hand  into 
the  uterus  with  strict  antiseptic  precautions, 
and  separating  the  placenta  gently  with  the 
ulnar  side  of  the  hand,  making  a  to  and  fro 
motion,  the  back  of  the  hand  being  towards 
the  uterine  wall.  On  any  portions  not  coming 
away,  they  might  be  peeled  off  by  using  the 
finger  nail  as  a  curette,  but  in  many  cases  it 
was  quite  impossible  to  get  all  removed  with- 
out using  undue  violence.  Then  it  was  better 
to  give  intra-uterine  douches  of  hydrargyrum 
perchloride,  followed  by  carbolic  or  creolin, 
and  allow  it  to  come  away  by  necrosis. 

In  conclusion,  Dr.  Browne  spoke  very 
strongly  against  the  following  methods  of 
removing  the  placenta; — i.  Dragging  on  the 
cord.  2.  Forcible  dragging  out  of  the  pla- 
centa by  the  hand  in  utero. 

Dr.  F.  W.  Campbell,  even  after  hearing  the 
previous  speakers,  believed  that  his  own  expe- 
rience of  32  years  was  as  reliable  as  any 
knowledge  he  could  acquire  from  the  text- 
books of  to-day.  He  thought  that  the  uterus 
itself  by  contraction  and  retraction  expelled 
the  placenta,  and  had  often  found  a  cough  or 


the  application  of  a  binder  very  useful.  He 
desired  to  enter  the  strongest  possible  protest 
against  the  modern  practice  of  employing 
chlotoform.  A  few  drops  on  a  towel  sufficient 
to  partially  stupify  migtit  be  an  advantage,  but 
few  women  would  be  content  with  this,  and 
very  little  more  produced  unconsciousness, 
with  entire  cessation  of  uterine  contractions. 
Moreover,  he  believed  it  to  be  invariably  fol- 
lowed by  a  tendency  to  haemorrhage,  and  he 
never  gave  it  except  when  compelled  to  do  so, 
and  then  only  when  the  head  had  been 
pressing  on  the  perineum  for  some  little 
time.  Quinine  in  full  doses  decidedly 
increased  uterine  contractions.  As  styp- 
tics, he  preferred  vinegar,  ice,  or  hot 
WiUer.  Wuh  regard  to  the  expulsion  of  the 
placenta,  ten  minutes  he  thought  had  been  the 
average  in  his  own  cases,  where  he  used  mani- 
pulation, and  traction  when  the  placenta  was 
in  the  vagina.  He  quoted  Sir  James  Simpson's 
rules.  Dr.  Campbell  separated  an  adherent 
placenta  WMth  the  front  of  the  hand  towards  the 
uterus  instead  of  the  reverse,  as  recommended 
by  Dr.  A.  A.  Browne. 

Dr.  G.  A.  Brown  used  chloroform  in  the 
vast  majority  of  his  cases  in  the  latter  part  of 
the  second  stage.  It  was  contra-indicated  in 
those  who  were  aUcTemic,  who  suffered  fro.m 
chronic  uterine  trouble,  and  who  had  weak 
pains  and  flabby  tissues,  as  then  it  was  apt  to 
be  followed  by  haemorrhage  after  the  expulsion 
of  the  placenta.  He  was  inclined  to  think  that 
during  the  third  stage,  ether  given  by  means  of 
the  Clover  inhaler  was  preferable.  Owing  to 
the  time  necessary  for  the  absorption,  he  novv 
gave  ergot  immediately  after  the  birth  of  the 
child  instead  of  at  the  end  of  the  third  stage, 
and  cited  three  cases  in  which  a  post-partum 
haemorrhage,  occurring  with  the  latter  method 
in  previous  labors,  had  been  prevented  at  sub- 
sequent ones.  He  believed  that  if  the  accou- 
cheur took  the  precaution  of  completely 
emptying  the  uterus,  styptics  could  be  to  a 
great  degree  dispensed  with  ;  when  necessary, 
he  used  hot  water  or  the  insertion  of  a  piece  of 
alum.  He  strongly  objected  to  perchloride  of 
iron,  as  it  greatly  increased  the  danger  of 
sepsis.  As  a  stimulant  after  excessive  haemor- 
rhage, he  used  strych.  nitrate  gr.  [-60  hypoder- 
mically.  He  considered  Crede's  the  only 
scientific  method  for  exjjulsion  of  the  placenta, 
and  in  cases  of  retention  followed  the  plan 
adopted  by  Dr.  A.  A.   Browne. 

ACADEMIE  DE  MEDECINE. 

Sudden  Death  on  the  Bicycle. — M.  L. 
H.  Petit  reported  three  cases  of  sudden  death 
following  the  use  of  the  bicycle,  all  in  per- 
sons suffering  from  a  cardiac  affection.  The 
first  case  was  that  of  man  60  years,  robust  in 
physique,  who  had  practised   with  his  teacher 


156 


THE   CANADA   MEDICAL    RECORD. 


for  a  month,  and  who,  during  a  lesson,  feeling 
indisposed,  called  the  teacher  and  died  in  his 
arms.  The  second  case  was  that  of  a  physician, 
who  wished  to  reduce  his  size  by  bicycle-riding. 
He  had  never  iiad  any  cardiac  trouble.  At  the 
end  of  several  months  he  was  attacked  with 
dyspncea  and  excessive  pain  in  the  heart.  He 
descended  from  his  machine,  seated  himself  on 
a  bench,  and  died  shortly  after.  I  he  third  case 
was  that  of  a  clubman,  about  40  years  old, 
who  died  on  his  bicycle  on  one  of  the  streets  of 
Paris.     He  also  had  a  cardiac  affection. 

From  the  ist  of  January  to  the  27th  of 
August,  the  Prefecture  of  Police  issued  32,996 
permits  for  the  use  of  the  bicycle.  As  many  per- 
sons do  not  apply  for  permits  until  compelled 
to  do  so,  it  may  be  said  that  there  are  about 
100,000  persons  in  Paris  who  use  the  velocipede. 
It  is  probably  not  an  exaggeration  to  estimate 
that  of  this  number  i  in  each  1000  suffers  from 
some  cardiac  trouble,  and  it  is  tiierefore  well 
to  call  attention  to  the  risks  which  they  run  in 
this  sport. 

Old  age  in  itself,  according  to  M.  Petit, 
should  be  regarded  as  a  contraindication,  with- 
out any  reference  to  heart  disease.  The  use  of 
the  bicycle  requires  a  suppleness,  an  attention, 
and  an  expense  of  strength  which  cannot  be  per- 
mitted to  elderly  persons  without  fear  of  bad 
results. — Gazette  des  Ifdpifaux,  September  11, 
1894. 


Iro^rcss    of    §ncnce. 


TREATMExNT       OF      STRANGULATED 
HERNIA. 

Dr.  G.  E.  Wherry  is  of  the  opinion  that 
all  cases  in  which  signs  of  strangulated 
hernia  have  existed  for  less  than  twenty-four 
hours  should  be  relieved  by  coughing-taxis, 
especially  in  inguinal  hernia  previously  reduci- 
ble. If  taxis  fail,  chloroform  should  be  given 
and  herniotomy  performed,  with  an  attempt  at 
radical  cure.  In  cases  in  which  taxis  is  suc- 
cessful, an  operation  for  radical  cure  should  be 
advised  before  the  return  of  ihe  patient  to  an 
active  life. — Practitioner,  SeiJtember,  1894. 

EFFEC  IS  OF  THYROID    ADMIXISTK  \- 
TION. 

In  a  paper  upon  myxtedema  and  thyroid 
extract,  Dr.  Geo.  W.  Crary,  of  New  York,  ex- 
jjresses  the  belief  that  many  so  called  idiots, 
imbeciles,  cases  of  arrested  development,  etc., 
among  children,  are  in  fjct  cases  of  functional 
inactivity  of  the  thyroid  gland,  and  hence  sus- 
ceptible of  treatment  by  thyroid  extract,  with 
improvement  and  perhaps  even  cure.  He 
summarizes  as    follows    the    effects   of  thyroid 


treatment :  Increased  metabolism,  shown  by  : 
(])  elevation  of  temperature  :  (2)  increased 
appetite,  wiih  more  complete  absorption  of 
nitrogenous  foods ;  (3)  loss  of  weight,  with 
nitrogen  excreted  in  excess  of  that  taken  in  the 
food  ;  (4)  growth  of  skeleton  in  the  very  young  ; 
(5)  marked  improvements  in  body  nutrition 
generally  ;  ^6)  increased  activity  of  mucous 
membranes,  skin,  and  kidneys.  The  rheuma- 
tic symptoms  and  the  angemia  are  not  only  not 
relieved,  but  are  most  frequently  aggravated. — 
America7i  Journal  of  Medical  Sciefices,  May, 
1894. 

DI.AGNOSIS     OF     TUBERCULOSIS     IN 
CHILDREN. 

Dr.  E.  Weill,  of  Lyons,  has  observed  a 
special  syndroma  in  three  cases  of  infantile 
pulmonary  tuberculosis  which  he  believes  to 
have  been  as  yet  unnoted.  It  consists  in  a 
sensation  of  cold  with  perceptible  lowering  of 
the  peripheral  and  central  temperature,  mark- 
ed cyanosis  of  the  extremities  with  noticeable 
modification  of  the  radial  pulse,  considerable 
alteration  of  the  number  of  red  cells  in  the 
cyanosed  portions  and  in  the  composition  of 
the  urine.  These,  conditions  are  readily  pro- 
duced by  having  the  patient  leave  his  bed, 
and  they  slow-ly  disappear  when  he  lies  down. 
They  are  transitory  symptoms,  of  an  inter- 
mittent character,  independent  of  the  clinical 
form  of  the  tuberculosis,  of  the  stage  of  the 
disease,  of  the  season,  or  of  the  diet. — Lyon 
Medical,  May  20,  1894. 

CHLORAL  HYDRATE— SOME  OF  ITS 

USES.* 

By  Ben.  H.  Brodxax,  M.D., 
Of  Brodnax,   Louisiana. 

In  conversation  with  physicians  at  various 
times,  I  have  noticed  they  viewed  chloral  as 
merely  a  hypnotic,  and  had  used  it  only  for  the 
purpose  of  relieving  pain,  thereby  inducing 
sleep.  I  have  been  a  little  surprised  at  this 
want  of  knowledge  of  its  other  equally  valuable 
properties.  Early  in  my  practice  I  tried  to 
make  a  few  medicines,  combined  or  by  them- 
selves, do  all  that  they  would  for  me,  and  was 
led  into  experimentation  with  them.  Cnloral 
came  in  for  its  share,  because  it  relieve<l  pain, 
(juieted  the  nervous  system,  and  did  not  par- 
alyze the  bowels. 

Asa  hypnotic,  five  grains  of  chloral  combined 
with  laudanum  or  with  one-eighth  or  one-quarter 
grain  of  morphine  acts  s[  lendidly,  the  com- 
bination intensifying  the  effects  of  each  and 
depriving  the  opiate  of  its  stimulating  property. 
\Vi,ih   children,  by  its  If,  in  sweetened  water,  it 


•  Read    hifoie    tlie     Piuladelphia     County    Medical 
Society,  by  O. scar  IL  Allis,  M.n.,June  13,  1894. 


THE   CANADA   MEDICAL   RECORD. 


157 


has  no    equal;  mixed  with    paregoric,  it  is  also 
good. 

\ prepare  it  as  follows  :  I  just  cover  the 
amount  in  my  case  vial  with  glycerin — this 
dissolves  it,  and  a  drop  is  about  a  grain.  In 
this  form  it  mixes  readily  with  oil  or  water  and 
is  more  quickly  prepared,  and  more  easily 
divided  into  doses,  large  or  small.  With  castor 
oil  the  dose  one  to  five  grains  renders  it  less 
nauseating,  and  does  not  gripe,  at  the  same 
time  producing  quiet  and  rest. 

Applied  to  the  skin  in  eruptive  diseases — 
measles,  urticaria — as  follows  :  Chloral,  10 
grains  (drops) ;  carbolic  acid,  10  grains  (drops)  ; 
water  or  oil,  1  to  2  ounces,  almost  instant  relief 
is  experienced  of  the  intense  itching;.  Or 
chloral,  10  drops;  glycerin  and  water,  each  Yi 
ounce,  produces  the  same  effect. 

Asa  mouth-wash:  Chloral,  10  grains;  gly- 
cerin and  water,  each  ^  ounce  (a  teaspoonful), 
produces  a  pleasant, cool  sensation  in  salivation, 
or  as  a  gargle.  After  holding  it  for  a  moment 
in  the  mouth,  it  should  be  rejected,  and  an  equal 
amount  of  the  fresh  solution  may  be  swallowed. 
Carbolic  acid  (10  drops)  added  makes  it  more 
effective  in  ulceration  of  the  mucous  coverings. 
It  seems  to  act  on  the  nerves  locally,  the  same 
as  chloroform  by  inhalation  does  on  the  body. 

In  toothache:  Chloral,  camphor,  glycerin, 
carbolic  acid,  equal  quantities,  applied  on  a 
small  piece  of  cotton  after  cleaning  the  cavity, 
will  relieve  the  pain.  (Cover  with  more  cotton 
to  fill  the  cavity.)  I  keep  the  mixture,  ready 
made,  under  the  name  of"  Toothache  drops,  " 
in  my  medicine  case.  If  the  patient  has  lost 
sleep  I  give  a  full  dose  of  chloral  by  the  mouth. 

For  ulcerated  sore-throat,  or  ulceration  from 
any  cause,  such  as  scalds  :  Chloral,  10  to  15 
drops  (grains)  ;  water,  i  to  2  ounces,  as  to  age  : 
sugar,  to  make  it  palatable  to  children,  a  tea- 
spoonful,  repeated  at  short  intervals  until  sleep 
is  induced,  then  on  waking  to  keep  them  fully 
under  its  influence.  My  first  experience  was 
on  my  only  daughter,  four  years  old.  The  case 
was  so  severe  I  feared  I  would  lose  her,and  toget 
rest  for  her,  gave  as  above,  after  having  tried 
everything  else  I  knew  of.  The  almost  inmiediate 
relief  of  all  the  bad  symptoms  led  me  to  think 
the  medicine  acted  othertcisc  than  merely  as  a 
restproduccr.  Since  then,  for  ten  years  I  have 
used  it  with  the  utmost  satisfaction  to  myself 
and  patients. 

Earache:  Camphor,  lo  grains;  chloral,  10 
grains  ;  carbolic  acid,  10  grains  ;  castor  oil,  54 
ounce.  Drop  into  the  ear  warm.  Fill  the  ear 
full,  apply  a  piece  of  cotton  wet  in  warm  water 
to  fill  the  external  ear,  then  a  cloth  wrung  out 
in  hot  water  as  warm  as  can  be  borne.  I  have 
seen  some  almost  crazy  children  go  to  sleep  in 
two  or  three  minutes,  and  awake  free  of  their 
troubles. 

As  an  aid  to  chloroform  in  surgery  or  obste- 
trics, 10   to  1  5  grains,  given  20  minutes  before 


administration  of  the  anaesthetic,  seems  to  in- 
tensify the  effect,  and  less  than  one  half  of  it  is 
needed  to  pioduce  the  desired  effect.  In  my 
obstetric  practice  for  the  last  fifteen  years  I 
have  used  it,  and  observed  but  one  case  where 
any  unpleasant  effects  were  induced.  This  was 
in  a  woman  with  her  tenth  child.  I  gave  tiie 
chloral  to  relax  the  system,  10  grains  ;  in  half 
an  hour  5  grains  more  ;  in  half  an  hour  the 
chloroform.  It  affected  her  almost  imme- 
diately, and^the  child  advanced  and  came  away 
in  good  style,  but  the  woman  seemed  to  be 
dead  drunk  and  incapable  of  moving  herself. 
She  slept  soundly  for  several  hours  and  awoke 
all  right.  She  was  conscious  and  would 
answer  questions,  but  coukl  not  use  herself. 
This  was  the  first  time  she  had  taken  either  of 
the  drugs,  and  she  may  have  been  susceptible 
—  easily  affected.  Chloral,  given  before  the 
ar. aesthetic,  seems  to  tide  them  over  the  ex- 
cited stage  of  anaesthesia.  The  first  few  whiffs 
of  the  anaesthetic  produce  quiet  without  any 
excitement,  I  have  used  it  in  a  few  surgical 
cases  with  the  same  effect.  In  children  a  full 
dose  of  chloral,  and  when  sleep  comes  on  they 
are  aucesthetized  in  that  state,  and  the  force, 
often  necessary  otherwise,  is  avoided. 

In  coryza,  where  the  Schneiderian  membrane 
is  very  irritable,  chloral,  10  grains  (or  drops)  ; 
castor  oil,  yn  ounce,  used  with  a  soft  mop,  ap- 
plied over  the  surface,  after  being  dried,  acts 
to  check  the  excretion  of  mucus,  and  lulls  the 
irritation  and  head-pains. 

The  supposed  influence  of  the  drug  on  the 
heart  has  been  urged  by  my  friends  against 
its  use.  I  have  not  seen  any  unpleasant  ef- 
fects. In  any  case  where  there  is  a  chance  of 
any  cardiac  trouble,  it  is  an  easy  matter  to  for- 
tify the  heart  with  a  1-50  grain  of  nitroglycerin. 
In  one  delicate  woman  I  did  this  as  a  precau- 
tion, but  even  in  her  case  I  believe  it  was  not 
necessary.  This  summarizes  my  experience 
with  chloral,  and  when  I  tell  you  I  use  from 
five  to  six  pounds  a  year,  you  may  know  that 
it  has  a  very  considerable  scope.  1  never  pre- 
scribe it  in  any  quantities,  so  as  to  create  a 
"habit."  In  fact,  I  do  not  know  of  a  single 
case  of  the  kind. — College  and  C/lnital  Record. 

SOME   RECENT  VIEWS    ON  APPENDI- 
CITIS.* 

By  J.  William  White,  M.D., 

Professor  of  Clinical  Surgery,  University  of  Pennsylvania. 

T.  The  explanation  of  the  great  frequency 
of  inflammation  of  the  appendix  is  to  be  found 
in  the  follovving  facts  :  — 

(.'?)  It  is  a  functionless  structure  of  low  vital- 
ity, removed  from  the   direct  faecal  current ;  it 


*Concliisions  of  an  address  deliveretl  before  the  Sur- 
gical Section  of  the  College  of  Physicians  of  Philadel- 
phia. 


158 


THE   CANADA   MEDICAL   RECORD. 


has  a  scanty  mesentery  so  attached  to  both 
r.^cum  and  ileum  that  it  is  easily  stretched  or 
twisted  wlien  they  become  distended  ;  it  de- 
rives its  blood-supply  through  a  single  vessel, 
the  calibre  of  which  is  seriously  interfered  with 
or  altogether  occluded  by  anylliing  which  pro- 
duces dragging  upon  the  mesentery. 

(I))  In  addition,  there  is  almost  always  pres- 
ent a  micro-organism — the  bacterium  coli  com- 
mune— capable  of  great  virulence  when  there 
is  constriction  of  the  ap>pendix  or  lesions  of  its 
mucous  coat  or  of  its  parietes. 

2.  The  symptoms  in  a  case  of  mild  catarrhal 
appendicitis — general  abdominal  pain,  umbili- 
cal pain,  localized  pain  and  tenderness  on 
pressure  in  the  right  iliac  fossa,  vomiting,  moder- 
ate fever,  and  slightly-increased  pulse-rate — 
canriot  at  present  with  any  certainty  be  distin- 
guished from  the  symptoms,  apparently  pre- 
cisely identical,  which  mark  the  onset  of  a  case 
destined  to  be  of  the  very  gravest  type. 

3.  It  must  be  determined  by  future  expe- 
rience whether  or  not  operation  in  every  case 
of  appendicitis,  as  soon  as  the  diagnosis  is 
made,  would  be  attended  by  a  lower  mortality 
than  would  wailing  for  more  definite  symptoms 
indicating  unmistakably  the  need  of  operative 
interference.  At  present  such  indication  exists 
in  every  case  if  the  onset  is  sudden  and  the 
symptoms  markedly  severe,  and  whenever  in  a 
mild  case  the  symptoms  are  unrelieved  at  the 
end  of  forty-eight  hours,  or,  a  fortiori,  if  at 
that  time  they  are  growing  worse. 

4.  It  must  be  determined  by  future  experi- 
ence whether  cases  seen  from  the  third  to  the 
sixth  day,  which  present  indications  of  the 
beginning  circumscription  of  the  disease  by 
adhesions,  and  which  tend  to  the  formation  of 
localized  abscesses,  will  do  better  with  imme- 
diate operation  with  the  risk  of  infecting  the 
general  peritoneal  cavity,  or  with  later  opera- 
tion when  the  circumscribing  wall  is  stronger 
and  less  likely  to  be  broken  through.  At  pre- 
sent, operation  is  certainly  indicated  whenever 
a  firm,  slowly-forming,  well-defined  mass  in  the 
right  iliac  fossa  is  to  be  felt  ;  or,  on  the  other 
hand,  when  a  sudden  increase  in  the  sharpness 
ai\jl  the  diffusion  of  the  pain  and  tenderness 
points  to  perforation  of  the  appendix  or  break- 
ing down  of  the  limiting  adhesions. 

5.  In  the  beginning  of  general  suppurative 
peritonitis,  operation  offers  som*  hope  of  suc- 
cess. In  the  presence  of  general  j^eritonitis 
with  septic  paresis  of  the  intestines,  operation 
has  thus  far  been  useless. 

6.  Recurrent  appendicitis  of  mild  type,  like 
acute  appendicitis,  frequently  results  from 
digestive  derangements.  Several  attacks  may 
occur  followed  by  entire  and  permanent  recov- 
ery, but  it  is  as  yet  imi)os-;ible  to  differentiate 
these  cases  accurately  from  those  which  do  not 
tend  to  spontaneous  cure.  Operation  is  cer- 
tainly indicated  whenever  the  attacks  are  very 
frequent. 


7.  Chronic  relapsing  appendicitis  is  charac- 
terized by  the  persistence  of  local  symptoms 
during  the  intervals  and  by  more  or  less  failure 
of  the  general  health.  It  usually  indicates 
operation. 

8.  Ill  either  the  recirrent  or  the  chronic  re- 
lapsing variety,  operation  should  be  advised 
according  to  the  following  indications  formu- 
lated by  Treves  :  whenever  (i)  the  attacks  have 
bsen  very  numerous.  (2)  The  attacks  are 
increasing  in  frequency  and  severity.  (3)  The 
last  attack  has  been  so  severe  as  to  place  the 
])atient's  life  in  considerab'e  danger.  (4)  The 
constant  relapses  have  reduced  the  patient  to 
the  condition  of  a  chronic  invalid,  and  have 
rendered  him  unfit  to  follow  any  occupation. 
(5)  Owing  to  the  persistence  of  certain  local 
symptoms  during  the  quiescent  period,  there  is 
a  probability  that  a  collection  of  pus  exists  in 
or  about  the  appendix. —  College  aiul  Clinical 
Record. 

TREATMENT  OF  POTT'S  DISEASE. 

An  interesting  and  valuable  paper  on  the 
above  subject  by  Phelps  appears  in  \\vq  Journal 
of  the  American  Medical  Association  for  Octo- 
ber 27,  1894,  in  which  the  following  treatment 
is  advised : 

In  lateral  curvature  of  the  spine,  effort 
should  be  made  to  develop  the  nmscles  of  the 
back  by  massage  and  proper  gymnastic  exer- 
cises. The  general  condition  is.  improved  by 
appropriate  food  and  exercise ;  and  in  cases 
where  deviation  of  the  spine  amounts  to  more 
than  half  the  diameter  of  the  vertebra,  a  sup- 
port to  prevent  absorption  of  the  vertebra  at 
point  of  curvature  is  imperatively  demanded. 
In  Pott's  disease  of  the  spine,  however,  the 
principle  of  treatment  is  the  reverse  ;  it  consists 
in  absolute  immobilization  and  extension  to  the 
point  of  comfort  to  relieve  the  pressure  be- 
tween the  diseased  vertebra. 

'llie  plaster-of-Paris  corset,  or  the  wood  cor- 
set with  lacings,  so  that  it  can  be  removed  at 
night,  are  the  best  forms  of  brace  devised. 
Aluminum  corsets  are  excellent  but  expensive. 
In  muscular  forms  of  curvature,  corsets  with 
steel  stiffening,  particularly  for  young  girls,  are 
very  satisfactory.  These  appliances  are  made 
while  the  ])atient  is  suspended  to  the  greatest 
amount  possible.  This  relieves  pressure  upon 
the  bodies  of  the  vertebrce,  and  stops  absorp- 
tion. The  corsets  are  removed  at  night,  ex- 
tension being  obtained  in  the  recumbent  pos- 
ture. When  the  patient  is  in  an  upright  posi- 
tion, with  the  corset  adjusted,  pressure  is 
relieved  and  absorption  must  necessarily  stop. 

In  Pott's  disease  of  the  spine,  the  patient  is 
fixed  in  an  apparatus  while  in  the  position  of 
suspension,  to  the  point  of  comfort.  The  cor- 
set which  is  adjusted  is  not  allowed  to  be  re- 
moved ;  it  is  put  on  and  permanently  worn. 
The  nurse  or  mother  can  remove  it,  which 
cannot  be  done  with  the  steel  brace.  It  is 
worn   with   comfort,   and  holding  the  spine,  as 


THE   CANADA   MEDICAL   RECORD. 


159 


it  does,  in  an  extended  position,  and  fixing  it 
belter  than  it  can  be  fixed  in  any  other  way, 
anchylosis  will  lake  place. 

No  brace  or  corset  of  any  description  that 
will  support  the  spine  can  be  applied  effectively 
to  a  child  under  tliree  years  of  age,  owing  to 
the  narrow  hips.  For  that  reason  the  writer 
has  devised  a  |)laster-of-Paris  portable  bed,  in 
which  the  child  is  placed  ;  this  permits  of  re- 
moval inio  the  open  air.  Bnnet's  wire  cuirass 
is  a  most  efficient  ai)paratu-,  but  is  more  ex- 
pensive than  the  plaster- of  Paris  portable  bed, 
and  no  better.  If  the  disease  is  located  above 
the  third  dorsal  vertebra,  no  corset  or  brace 
without  the  aid  of  the  jury-mast  can  be  ad- 
justed so  as  to  be  a  support,  owing  to  the  fact 
that  the  weight  of  the  head  and  shoulders  op- 
erate upon  the  point  of  disease  or  curve.  In 
these  cases  the  jury-mast  should  always  be  so 
adjusted  as  to  transmit  the  weight  of  the  head 
through  the  corset  to  the  hips. 

To  make  proper  corsets  from  plaster-of-Paris, 
suitable  material  must  be  used.  H.  B.  Clatiin 
&  Co.  make  for  the  author  a  special  crinoline, 
known  as  No.  100  h  )spital  crinoline;  it  has 
the  proper  amount  of  sizing  and  material  and 
a  total  absence  of  indigo.  The  plaster  of 
Paris  is  furnished  by  the  White  Dental  Manu- 
facturing Company,  put  up  in  fifty-pound  tin 
packages,  fresh  from  the  oven.  This  cloth  and 
plaster  of  Paris,  when  properly  united,  make  a 
perfect  plaster  bandage.  The  crinoline  should 
be  torn  in  strips  six  inches  wide  and  six  yards 
long  ;  the  cloth  is  drawn  over  a  pile  of  plaster 
of  Paris  on  a  table,  and  all  rubbed  off  uixcepting 
enough  to  simply  fill  the  mesh  of  the  cloth  ; 
the  bandage  is  loosely  rolled,  that  it  may  take 
water  quickly.  A  tight  fitting  shirt  is  now  ad- 
justed to  the  patient.  The  patient  with  lateral 
curvature  suspends  himself  to  the  greatest  pos- 
sible extent.  In  Pott's  disease  the  arm-pieces 
are  used  and  the  patient  suspended  to  the  point 
of  comfort.  The  dinner-pad  is  placed  un  ier 
the  shirt ;  three  or  four  bandages  placed  in 
water ;  one  of  these  is  wound  snugly  around 
the  body  just  above  the  crest  of  the  ileum, 
making  two  or  three  turns  ;  then  the  hips  are 
enveloped  down  to  the  great  trochanter,  using 
one  or  two  bandages  at  this  point.  We  should 
begin  at  the  bottom  of  the  corset  each  time, 
and  roll  on  the  bandages  up  to  the  armpits, 
rubbing  each  layer  until  there  is  no  longer  air 
in  the  meshes  of  the  cloth.  Six  bandages  will 
do  for  a  child  under  seven  years  ;  from  eight 
to  twelve  for  adults.  When  the  plaster  is  set- 
ting, we  should  stand  behind  the  patient  and 
gently  press  the  corset  in  over  the  crest  of  the 
ileum  and  firmly  against  the  ribs.  After  tiie 
corset  lias  firmly  set,  the  dinner-pad  is  re- 
moved and  the  corset  sprung  antero-poste- 
riorly,  to  throw  it  off  the  antero-posterior 
spinous  process,  to  prevent  excoriations.  T.ie 
corset  is  cut  off  at  the  bottom  and  top,  being 


left  on  jieimanently  in  case  of  Pott's  disease. 
In  lateral  curvature  the  corset  is  cut  off,  the 
edges  trimmed  with  lacing,  and  an  elastic 
durable  spinal  brace  results. 

If  the  patient  desires  a  wood  corset,  fill  the 
plaster  of-Paris  corset  with  plaster,  which 
makes  a  cast  of  the  body,  upon  which  the  wood 
corset  is  m.ade. 

The  corset  in  Pott's  disease  should  be  worn 
from  six  months  to  a  year  without  removal ;  in 
lateral  curvature  it  .'should  be  removed  each 
night.  Proper  exercise,  forcible  redressment, 
gymnastics,  and  so  on  should  be  used. 

The  plaster-of-Paris  corset  is  sent  to  the 
foundry  in  case  an  aluminum  corset  is  de- 
sired, the  anvil  is  made,  and  upon  this  the 
aluminum  is  worked  ;  this  is  the  most  beuitifiil 
corset  made. —  Therapeutic  Gazette. 

THE  ANTITOXIN  TREATMENT  OF 
DIPHTHERIA. 

The  topic  which  just  now  is  absorbing  the  at- 
tention of  the  i^rofession  and  the  laity  almost  to 
the  exclusion  of  all  else  medical  is  diphtheria  and 
its  treatment  by  means  of  Bjhring's  antitoxin. 
No  society  meets  th  it  the  theme  is  not  brought 
up  for  discussion,  whi'e  the  writers,  (he  talkers, 
and  the  hospital  attendants  are  daily  producing 
an  amount  of  matter  so  great  that  the  medical 
press  groans  to  get  quit  of  it,  but  without  avail. 

Already  the  literature  of  the  subject  is  heavy 
and  voluminous,  and  he  who  attempts  to  read 
it  finds  it  crude,  chaotic,  and  confusing. 

Much  winnowing,  sifting,  and  condensing 
will  have  to  be  done  before  the  conscientious 
doctor  who  wants  the  truth,  and  desires  to 
apply  it  in  practice,  can  settle  the  question  as 
to  whether  he  shall  inject  or  not  inject,  ])utting 
his  patient  to  the  extra  expense  of  forty  or  fifty 
dollars  for  drugs  in  each  case,  or  saving  him 
from  what  is  a  manifest  extortion  on  the  part 
of  the  producers  of  the  new  remedy. 

What  is  the  duty  of  the  general  practitioner 
at  this  writing  can  scarcely  be  set  down.  If  he 
fail  to  apply  the  remedy  and  the  patient  should 
die,  he  will  be  severely  criticized.  If  he  employ 
it,  and  the  patient  die,  he  will  be  accused  of 
having  experimented  upon  the  victim  with  a 
fruitless  and  exj^ensive  fad.  If,  however,  the 
patient  should  recover  under  the  new  remedy, 
it  may  still  be  said  that  many  patients  have  got- 
ten well,  and  probably  this  one  would  have 
done  so  without  the  antitoxin,  and  that  still  the 
doctor  is  experimenting  with  expensive  and 
fruitless  fads. 

Just  what  the  doctor's  duty  in  the  case  is 
cannot  be  stated  till  time  shall  give  us  a  great 
number  of  reports,  and  some  gifted  compiler 
shall  deduce  from  the  vast  accumulation  of 
literature  upon  the  topic  a  volume  of  statiitics 
reducing  the  question  to  a  mathematical  cer- 
tainty. Till  then  we  think  the  practitioner 
would  do   well  to  lay  the  question  of   the  new 


i6o 


THE   CANADA   MEDICAL   RECORD. 


treatment  fairly  before  each  patient  or  liis 
friends,  and  to  advise  its  use  in  all  cases  where- 
in the  financial  condition  of  the  family  will 
allow  of  it. 

Statistics  to  date,  so  far  as  ihcy  are  attainable, 
pronounce  the  treatment  effective  in  tlie  saving 
of  life;  but  the  usual  libera!  discount  must  be 
made  in  drawing  conclusions  from  the  reports 
of  enthusiastic  experimenters  with  new  reme- 
dies.— Atniricaii  Practitioner  and  Ncii<s. 

PERNICIOUS   AN.EMIA    AT   THE  AGE 
OFTWENIY-ONE. 

Pernicious  anaemia  is  not  often  met  with  dur- 
ing the  first  twenty  five  years  of  life,  and  a  case 
observed  by  Dr.  W.  R.  Gowers,  of  London, 
is  therefore  worthy  of  mention.  The  patient, 
a  young  man  aged  21  years,  seen  February  19, 
presented  the  appearance  of  extreme  chlorosis, 
the  skin  having  the  characteristic  lint,  the  gums 
and  conjunctiva;  being  very  pale.  He  was 
feeble  and  readily  rendered  short  of  breath. 
'1  he  condition  had  come  on  gradually  during 
the  previous  six  months,  before  which  time  the 
patient  had  seemed  in  good  health,  though  he 
had  been  delicate  as  a  young  child.  The  per- 
centage of  hemoglobin  was  but  a  little  over  30, 
and  of  red  corpuscles  only  25  per  cent.  Exam- 
ination of  the  eyes  showed  numerous  fiamed- 
shaped  haemorrhages  in  each  retina,  and  one 
or  two,  of  more  irregular  shape,  near  the  disc. 
Haemorrhages  iiad  occurred  a  month  previously. 
In  spite  of  careful  treatment  the  patient  stead- 
ily failed.  There  was  some  elevation  of  tem- 
perature for  a  {q.\v  days,  and  pyrexia  returned 
on  March  19th,  when  a  large  haemorrhage  oc- 
curred in  the  right  eye.  Vomiting  set  in,  and 
the  patient  died  on  March  2tst. 

Such  a  case,  says  Dr.  Gowers,  lends  itself 
to  the  current  tendency  to  associate  all  sorts  of 
diseases  with  specific  organisms  ;  but  another 
hypothesis  deserves  consideration,  viz.,  the 
failure  of  tissues  soon  after  they  complete  their 
development,  not  unknown  in  other  structures, 
— an  inherent  defect  of  vital  endurance  on  the 
part  of  the  blood-making  tissues. — British 
Medical  Journal, M.a.y  12,  1894. 

*  MENINGITIS  OF  OBSCURE    CAUSA- 
TION. 

Dr.  F.  Carr  Boitomley,  of  St.  George'^ 
Hospital,  London,  in  a  study  of  this  subject, 
arrives  at  the  following  conclusions:  i.  It  is 
difficult  to  say  whether  certain  cases  of  menin- 
gitis have  been  due  to  turbercle  or  not.  Meniti- 
gitis  may  probably  be  turberculous  without  any 
turbercles  being  visible  in  the  meninges, — at 
any  rate,  to  the  naked  eye.  Bacteriology  helps 
us  10  decide  whether  this  has  been  the  cause. 
2.  It  is  also  difficult  to  decide  whether  certain 
cases  are  due  to  ear  disease  ;  the  presence  of 
signs  of  old  or    recent   otitis  media  does  not 


necessarily  show  that  the  meningit  is  was 
secondary  to  this  ;  bacteriology  probably  helps 
us  to  decide  the  question  only  in  the  case  of  old 
ear  disease.  3.  Some  cases  of  meningitis  follow- 
ing broncho-pneumonia  and  empyema  are  proba^ 
bly  of  a  septic  nature.-  4.  There  is  no  evidence  of 
Bright's  disease  being  a  cause  of  meningitis.  5. 
Idiopathic  cases  are  characterized  by  the  follow- 
ing  points  :  (<jf)  Both    brain  and  spinal  cord 

I    are  frequently  attacked,    and  sp'nal  symptoms 

I  are  common  ;  these  symptoms  are  rare  in  other 
varieties  of  meningitis  which  attack    both  brain 

I  and  cord,  if  we  consider  retraction  of  the  head 
to  be  not  necessarily  a  spinal  symptom.  In 
some  cases  spinal  appear  before  cerebral  symp- 
toms,    {h')  The  duration  of  illness  varies  from 

'  one  to  four  weeks,  the  variation  depending 
mainly  on  the  stage  of  the  disease  at  which  the 
cerebral  membranes  become  affected,  {c)  Recov 
eries  are  fairly  frequent,  {d)  The  best  treat- 
ment seems  to  consist  in  the  administration  of 
mercury  and  iodides,  {e)  The  affection  of  the 
cerebral  membranes  may  be  either  at  the  vertex 
or  the  base,  or  both.  (/")  The  cases  occur 
perhaps  most    frequently   in  the  cooler  part  of 

'  the  year.  6.  There  is  some  evidence  for  consi- 
dering these  cases  to  be  associated  with  epidemic 

I  meningitis,  and  for  considering  that  the  cause 
of  both  may  be  the  diplococcus  pneumonia. — 
Practitioner,  June,    1894. 

A  CASE  OF  T.F:NIA  NANA 'IX  A  CHILD. 

Dr.  Rasch,  of  Bangkok,  had  under  his  caie 
a  girl  of  7  years,  in  whom  disturbances  of  digest 
tion,  conbined  with  an  insomnia  which  could 
not  be  accounted  for,  led  him  to  suspect  the 
possibility  of  helminthiasis.  Examination  show- 
ed the  presence  of  oxyuris  and  the  eggs  of  taenia. 
Male  fern  was  administered,  and  a  large  quan- 
tity of  white  filaments,  fifty  or  eighty  in  numbe- 
and  one  or  two  centimetres  in  length,  were 
passed,  which  proved  to  be  the  taenia  nana. 
The  child  has  never  been  out  ofSiam. 

Taenia  nana  is  rare  in  the  human  subject,  but 
three  or  four  cases  having  so  far  been  reported 
by  Bilharx,  of  Cairo  ;  Blanchard,  of  Belgrade  ; 
and  Grassi,  of  Sicily — Deutsche  mcdizinal-Zei- 
iung,'^o.  13,  1894. 

THE    VALUE   OF    SUGAR     AND    THE 
EFFECT  OF  SMOKING  ON  MUSCU- 
LAR WORK. 

As  the  result  of  a  series  of  experimental 
researches  in  the  Physiological  Institute, 
Turin,  upon  this  subject,  Vaughan  Harley 
has  come  to  the  following  conclusions:  i. 
The  periods  of  digestion  as  well  as  the  kinds  of 
food  taken  have  a  marked,  influence  on  volun- 
tary muscular  energy.  2.  Irrespective  of  the 
influence  of  food,  there  is  a  periodical  diurnal 
rise  and  fall  in  the  power  of  performing  mus- 
cular work.     3.  More  work  can   be  done  after 


THE  CANADA   MEDICAL   RECORD. 


l6l 


than  before  mid-day.  4.  The  minimum  amount 
of  muscular  power  is  in  the  morning  about  9  a.m., 
the  maximum  about  3  in  the  afternoon.  5.  Regu- 
lar muscular  exercise  not  only  increases  the  size 
and  power  of  the  muscles,  but  has  tlie  effect  of 
markedly  delaying  the  approach  of  fatigue.  6. 
The  amount  of  work  performed  on  a  diet 
of  sugar  alone  is  almost  equal  to  that  obtained 
on  a  full  diet,  fatigue,  however,  setting  in 
sooner.  7.  In  fasting,  large  quantities  of  sugar 
(500  grammes)  (i  6  ounces)  can 'increase  the 
power  of  doi-ng  muscular  work  during  30  volun- 
tary contractions  from  26  to  ;^;^  per  cent.,  while 
the  total  gain  in  a  day's  work  may  b."  61  to  76 
per  cent.,  the  time  before  fatigue  sets  in  being 
also  lengthened.  8.  The  effect  of  sugar  is  so 
great  that,  when  added  to  a  small  meal,  it  can 
increase  the  muscular  power  during  30  contrac- 
tions from  9  to  12  per  cent.,  white  the  total  in- 
crease in  work  may  be  from  6  to  39  percent., 
the  approach  of  fatigue  being  at  the  same  time 
retarded.  9.  When  added  to  a  large  mixed 
meal,  sugar  can  increase  the  muscular  power  of 
30  contractions  2  to  7  per  cent.,  the  increase  in 
total  work  being  8  to  16  per  cent.,  and  a  mark- 
ed increase  in  the  resistance  to  fatigue  is  shown. 
10.  Two  hundred  and  fifty  grammes  (8  ounces) 
of  sugar  taken  in  addition  10  a  full  diet  increase 
the  day's  work  ;  the  work  accomplished  dur- 
ing 30  voluntary  muscular  contractions  shows 
a  gain  of  from  6  to  28  per  cent.,  the  total  day's 
work  giving  an  increase  of  power  9  to  36  per 
cent.,  and  the  time  before  fatigue  sets  in  being 
lengthened.  11.  Moderate  smoking,  although 
it  may  have  a  slight  influence  in  diminishing  the 
power  of  doing  voluntary -muscular  work,  neither 
stops  the  morning  rise  nor,  when  cone  early  in 
the  evening,  hinders  the  evening  fall.  12. 
Sugar  taken  early  in  the  evening  is  capable  of 
obliterating  the  diurnal  fall  in  muscular  power 
that  occurs  at  this  time,  and  increases  the 
resistance  to  (Rllgue. —/our/ia/  of  Physiology, 
vol.  xvi,  Nos.  I  and  2,  1894. 

SCORBUTUS  IN  INFANTS. 

DrWm.  P.  Northrup  advances  the  following 
conclusions,  based  on  an  exhaustive  study  of 
the  subject  ;  i.  Scurvy  may  appear  at  any  period 
of  infancy  or  early  childhood,  but  is  most  com- 
mon between  the  ninth  and  fourteenth  months. 
2.  The  lesions  are  hsemorrhagic  in  character, 
due  probably  to  diapedesis.  The  most  character- 
istic are  subperitoneal  haemorrhages.  Haemor- 
rhages into  the  muscular  tissues,  the  skin,  and 
mucous  membrane  are  more  or  less  constant.  3. 
It  occurs  in  every  grade  of  the  social  scale,  but 
is  more  frequent  among  the  rich  than  the  poor. 
The  neglected  child  who  eats  everything  at 
table  may  become  rachitic  or  marasmic,  but  he 
obtains  enough  fresh  food  to  protect  him  from 
scurvy.  It  very  rarely  occurs  in  asylums  and 
hospitals,    because  in  recent   years    feeding  in 


such  institutions   has  been   more  rational  than 
in  many  private  families.     4.  Lack  of  fresh  food 
is  the  most   important    cause.     The  use  of  the 
proprietary  foods  and  condensed  milk  produces 
more  scurvy  than    all  other  .causes  combined. 
Even  fresh  milk    in    small    proportions  is  not 
sufficient  to  insure  protection.     5.  Anaemia  and 
malnutrition  are  almost  invariably  present  ;  a 
peculiar    sallow    complexion    is  common.     6. 
Scurvy  is  frequently  supperadded  to  rachitis,  but 
in  a  considerable  number  of  cases  no  evidences 
of  rachitis  are  present.     So-called  acute   rickets 
is  in  most  cases,  probably  in  all  rickets,  compli- 
cated by  scurvy.     7.  Pain  is  a  constant  symp- 
tom ;  it  develops    early  and  is   usually  intense. 
8.  A  varying  degree  of  immobility  of   the  ex- 
treaiities  is  common,  and  is  frequently  so  marked 
as    to   simulate    paralysis.       This    pseudo-par- 
alysis disappears  with  the  subsidence  of  the  scor- 
butic symptoms.  9.  Subcutaneous  haemorrhages, 
as  well  as  haemorrhages  from  the  cavities  of  the 
body,  are  very  common,    but  are  not  necessary 
to  a  diagnosis    of  scurvy.     10.  The  condition 
of  the  gums  is    characteristic.     They   are  pur- 
plish, soft,  spongy,  and  bleeding,  and  frequently 
show   decided    ulcerations.     When  the   teeth 
have  not  been  erupted,    changes    in  the  gums 
are  usually  slight  or  entirely  absent.     1 1.  Pain- 
ful   swelling   of  the    lower   extremities  is    the 
most  constant  symptom ;  the  upper  extremities 
are  rarely  involved.     The  thigh  is  affected  more 
frequently    than  any   other  region.     12.  Child- 
ren   suffering    from  scurvy  commonly  present 
the  following  symptoms  :  anaemia,  intense  pain 
on  motion,  spongy  and    bleeding  gums  ;   swell- 
ing of  the  lower  extremities,  usually  at  the  thigh. 
There    may   also   be   purpura  or   ecchymoses, 
discharge  of  blood  from  the  various   cavities  of 
the  body,   and  pseudo-paralysis.     13.    Scurvy, 
when  untreated,  is  a  very  fatal  disease ;  when 
recognized  and  properly    treated,  a  rapid  and 
complete  cure  is  usually  effected.     The  result 
of  anti-scorbutic  treatment  is,  in  fact,  one  of  die 
most  certain   means  of  diagnosis.     14.  Scurvy 
may  be  mistaken  for  rheumatism,    stomatitis, 
rickets,    sarcoma,  osteitis,  and  infantile  para- 
lysis.    15.  Scurvy   is    a    dietetic  disease,    and 
must  be  cured   by   dietetic  treatment.     Fresh 
milk,  beef-juice,  and  orange-juice  are  the  most 
effective  remedies. — New  York  Medical  Jour- 
nal, May  26,  1894. 

SUBCUTANEOUS  INJECTION  OF  ARTI- 
FICIAL SERUM  IN  SERIOUS 
HEMORRHAGE. 

Lemoine  reports  the  case  of  a  young  woman, 
who  lost  a  large  amount  of  blood  during  preg- 
nancy, cured  by  the  injection  of  artificial  serum. 

The  liquid  employed  has  the  following  com- 
position : 

Sodium  pliosphate, 

Sodium  chloride,  of  each,  5ii  ; 

Water,  Oii. 


1 62 


THE   CANADA   MEDICAL   RECORD. 


He  injected  i  ^  pints  of  this  fluid  into  the 
buttocks  of  the  patient,  and  three  hours  after- 
wards the  symptoms,  as  well  as  the  fluid,  had 
totally  disappeared. — Revue  McdicoChirurgi- 
cale  des  Maladies  des  Femmes,  August  25, 
1894. 

CLASS-ROOM    NOTES. 

— Digitalis^  Trof.  Hare  says,  is  a  powerful 
stimulant  to  the  heart,  and  not  a  sedative. 

— Colchicine,  Prof  Hare  says,  does  not  dis- 
order the  stomach  as  easily  as  colchicum. 

— Appendicitis,  Prof.  Keen  says,  occurs 
about  three  times  as  often  in  the  male  sex  as  in 
the  female. 

— Prof.  Hare  says  the  Oil  0/  Copaiba  is  not 
as  therapeutically  active  as  the  balsam  of 
copaiba. 

— Prof.  Keen  says  Gall  stories  that  escape 
from  the  gall-bladder  will  often  be  the  cause  of 
obstruction  at  the  ileo-ca^cal  valve. 

— Prof  Hare  is  of  the  opinion  that  some 
cases  of  Ptieumonia  can  be  aborted  if  they 
are  seen  early  enough. 

— Prof.  Montgomery  say.":  Lacerated  Perine- 
urns  sewed  up  during  the  period  of  lactation 
often  do  not  heal  well. 

—  Chloral,  according  to  Prof.  Hare,  is  the 
best  and  purest  hypnotic,  but  it  will  not  relieve 
pain. 

— Fun}ious  Cro'a'ths  2ii  the  slump  of  the  um- 
bilical cord.  Prof.  Parvin  says,  can  generally  be 
gotten  rid  of  by  dusting  with  burnt  alum. 

— Large  doses  of  atropine.  Prof.  Hare  says, 
should  not  be  administered  to  Nursing  Mothers, 
since  it  is  largely  eliminated  in  their  milk. 

— Prof  Parvin  believes  that  an  excessive  and 
overworked  condition  of  the  kidneys  is  the 
cause  of  Albuminuria  in  the  pregnant  woman. 

— Convulsions  at  the  outset  of  pneumonia, 
Prof.  Wilson  says,  are  of  very  common  occur- 
rence in  children,  taking  place  in  almost  one- 
half  of  all  the  cases. 

— According  to  Prof.  Parvin,  if,  after  eight- 
een hours  from  time  of  delivery,  the  mother 
does  not  voluntarily  empty  the  bladder,  she 
should  be  catheterized. 

— Prof  Montgomery  says  the  dressings  in  a 
case  of  Abdominal  iicction  should  not  be  re- 
moved for  ten  days  after  the  operation,  unless 
complications  set  in. 

— Prof.  Parvin  does  not  think  that  hamamelis 
is  a  safe  remedy  to  administer  to  a  woman  in 
the  treatment  of  Hemorrhoids,  if  she  be  in  a 
pregnant  condition. 

— In  2.  Depressed  Fracture  of  the  Skull,  Prof 
Keen  says,  even  if  no  nervous  symptoms  mani- 
fest themselves,  tlie  skull  should  be  trephined 
and  the  depressed  part  elevated. 


— If  the  temperature  in  Diphtheria  remains 
high  for  days  at  a  time.  Prof.  Wilson  says  it 
is  due  generally  to  some  pulmonary  or  other 
complication  and  not  to  the  diphtheria  itself. 

— One  of  the  mos-t  prominent  symptoms  of 
Fracture  of  the  Clavicle,  Prof.  Brinton  says, 
is  that  the  patient  is  unable  to  place  the  hand 
of  the  injured  side  on  the  shoulder  of  the  sound 
side. 

— Prof  Wilson  says  the  chill  which,  as  a 
rule,  is  present  at  the  outset  of  an  attack  of 
Pneumonia  often  does  not  manifest  itself  in 
children,  but  is  supplanted  by  nervous  symp- 
toms. 

— Prof  Brinton  does  not  favor,  in  cases  of 
Fracture  of  the  Hu?nerus,  the  splinting  of  the 
upper  arm  only,  and  leaving  the  forearm  with- 
out any  splint  or  support  other  than  a  sling. 

— For  Enlarged  Thyroid  Glands,  Prof. 
Parvin  recommends  the  local  application  of  an 
ointment  consisting  of  from  twenty  to  thirty 
grains  of  the  biniodide  of  mercury  to  half  an 
ounce  of  simple  ointment. 

— Prof.  Brinton  says,  in  examining  the 
Scapula  for  possible  fracture,  the  arm  should  be 
carried  behind  and  ujjward  on  the  back,  which 
will  cause  the  scapula  to   extend  prominently. 

■ — Prof.  Wilson  says  a  peculiarity  of  Rhcu- 
7natic  Fever,  which  in  obscure  cases  becomes 
an  important  diagnostic  point,  is  the  occur- 
rence of  irregular  sweats,  which  bear  no  rela 
tion  whatsoever  to  the  fall  of  the  temperature. 

— Prof  Hare  says  there  is  no  drug  which  has 
as  good  an  influence  on  true  Gout  as  colchicum. 
The  best  preparation  to  use  in  these  cases,  he 
thinks,  is  the  wine  of  the  root  of  colchicum,  in 
the  dose  of  from  five  to  twenty  drops. 

— When  Diphtheritic  Exudations  are  laryn- 
geal or  sublaryngeal.  Prof.  Wilson  says  steam  in- 
halations, consisting  of  one  part  alcohol  and 
five  parts  of  water,  will  be  found  not  only  to 
give  much  relief,  but  to  be  also  very  beneficial, 

— In  any  case  of  Injury  to  the  Head,  in 
which  a  patient  vomits  blood,  Prof.  Keen  says 
a  fracture  of  the  base  of  the  skull  will  be  found 
in  nine  out  of  every  ten  cases.  The  vomited 
blood  will  be  blood  that  has  trickled  from  the 
fracture  and  has  been  swallowed  by  the  patient. 

— Prof.  Parvin  says  that  one  of  the  differential 
diagnostic  signs  between  Hydnemia  and 
Albuminuria  in  the  i)regnant  woman  is  that 
the  tedema  of  the  lower  limbs  in  hydr.xmia 
disappears  when  the  patient  is  at  rest,  while  if 
it  be  due  to  an  albuminuria,  it  does  not  disap- 
pear. 

— Prof.  Wilson  says  in  a  case  of  Croupous 
Pneumonia,  when  the  disease  extends  itself 
from  one  lobe  of  the  lung  to  another,  or  when 
it  travels  from  one  lung  to  the  other,  we  do  not 
have  a  chill  such  as  manifests  itself  at  the  out- 
set of  the  disease. 


THE   CANADA   MEDICAL   RECORD. 


163 


— In  cases  of  Injury  to  the  Head,  Prof.  Keen 
says  if  at  the  edges  of  the  wound  a  ring  is 
formed  by  the  effiision  which  is  hard  and  well 
marked,  it  will  no  doubt  be  found  to  be  a  con- 
tused wound  ;  while  if  the  margins  of  the  wound 
are  found  to  be  soft  and  not  well  marked,  the 
chances  are  that  a  depressed  fracture  has  taken 
place. 

— Prof.  Parvin  says  if  Excessive  Uterine 
Contractions  occur,  and  on  account  of  the  un- 
yielding condition  of  any  portion  of  the  birth 
canal,  a  tear  is  likely  to  take  place  from  rapidity 
of  the  labor,  free  inhalations  of  chloroform 
must  be  given  in  order  to  moderate  the  uterine 
forces. 

— Often  in  the  new-born,  Prof.  Parvin  says, 
within  a  week,  both  in  the  male  and  in  the 
female  child,  a  Secretion  of  Milk  occurs  ;  this 
is  best  gotten  rid  of  by  bdthing  the  breast  in 
hot  water  and  then  applying  a  warm  mixture  of 
three  parts  of  sweet  oil  and  one  part  of 
camphor. 

— Prof.  Hare  does  not  think  that  chloroform 
is  a  very  good  remedy  in  cases  of  Puerperal 
Eclampsia,  on  account  of  the  danger  of  post- 
partum hemorrhage  due  to  the  relaxation  of  the 
muscles  of  the  uterus.  There  is  also  the 
danger  from  its  use  of  cardiac  failure  brought 
on  by  a  sudden  exertion  due  to  the  convulsive 
movements  of  eclampsia. 

— In  Pneumonia,  when  the  disease  attacks 
the  lower  lobes  of  the  lungs,  Prof  Wilson  says 
the  pain  is  more  severe  than  if  another  part  of 
the  lung  is  attacked. 

— Prof.  Hare  says  cases  of  Tonsillitis,  espe- 
cially if  associated  with  rheumatism,  will  very 
often  be  relieved  by  guaiac,  when  all  other 
drugs  seem  to  yield  no  effect. 

— Prof.  Parvin  says  that  it  has  been  noted 
that  Eclampsia  manifests  itself  with  special 
virulence  at  times  in  a  certain  territory,  and  at 
special  times  more  than  at  others. 

— In  the  intermitting  {oxyxioi  Malarial  Fever 
the  paroxysms  of  fever  last  from  three  to  four 
hours,  while  in  the  remittent  form  they  last  from 
fifteen  to  eighteen  hours,  according  to  Prof. 
Wilson. 

— Any  case  of  Epilepsy  developing  sudden- 
ly in  a  patient  who  is  passed  thirty-five  years 
of  age,  and  who  gives  no  history  of  injury. 
Prof.  Hare  says  is  almost  invariably  caused  by 
syphilis. 

— The  most  efficient  remedy  that  can  be  em- 
ployed in  cases  of  Cystitis  in  the  female,  ac- 
cording to  Prof.  Parvin,  is  the  washing  out  of 
the  bladder  with  a  weak  solution  of  creolin. 

THERAPEUTIC  BRIEFS. 

— Iodine  has  been  found  to  be  one  of  the 
most  effective  agents  for  destroying  the  parasite 
upon   which   Ringworm    depends.      (^Modern 


Medicine^  An  excellent  method  of  applying 
it  is  the  following :  Thoroughly  cleanse  the 
scalp  with  soap  and  water.  Dry  perfectly, 
then  apply  a  solution  of  one  partof  pure  iodine 
in  thirty  parts  of  flexible  collodion.  Renew  the 
application  each  day  for  four  days.  At  the 
end  of  fifteen  days,  remove  the  collodion,  wash 
the  scalp  first  with  soap  and  water,  then,  after 
thoroughly  removing  the  soap,  wash  with  a  hot 
solution  of  bichloride  of  mercury,  1-2500.  After 
allowing  the  bichloride  solution  to  remain  in 
contact  with  the  scalp  for  half  an  hour,  wash 
with  pure  water,  dry,  and  apply  vaseline  or  zinc 
ointment.  If  necessary,  repeat  the  application. 
— For  relief  of  Pruritus,  the  following  ap- 
plication suggested  by  Bronson  has  been  found 
useful : — 

I^ .     Acid,  carbolic, 

Liquor,  potassa^,  aa  f3J 

Olei  lini,  f§j 

Olei  bergamot,  gtt.  ij.     M 

SiG. — Shake  well  and  apply  locally. 
— IcHTHYOL  is  proving  itself  to  be  one  of  the 
most  valuable  drugs  in  the  materia  medica. 
(^Modern  Medicine?)  An  ointment  consisting, 
of  twenty-five  per  cent,  of  ichthyol  and  seventy- 
five  per  cent,  of  lanolin  is  the  very  best  remedy 
for  erysipelas.  Ichthyol  is  also  useful  in  rheu- 
matism, in  the  form  of  an  ointment  consisting 
of  equal  parts  of  lanolin  and  ichthyol. 

— The  following  is  an  excellent  Antiseptic 
Snuff-Powder  (Dr.    L.   A.    Dessar,  Interna- 
tional Journal  of  Surgery)  : — 
5.     Menthol, 
Tannic  acid, 
Boracic  acid. 
Bismuth  subnitrate, 
Starch, 
Cocaine, 
Aristol, 
SiG. — Make  a  fine  powder. 
— For  Chilblains  {Amer.  Med.  Surg.  Bui* 
letin)  Dr.  James  R.  Wood  employs  the  follow- 
ing :— 

5.     Zinci  oxidi, 
Camphoroe  pulv., 
Myrrhae  pulv., 
Opii  pulv.,  aa 

Adipis, 

— For   Painful  Defecation,  attending  in- 
flammatory   pelvic     conditions,     Dr.    Murray 
{Norsk   Magazin   for  Lcegevid) 
the  following  : 

I^ .     Bismuth  subnitrate. 
Mercurial  ointment, 
Extract  of  belladonna. 
Cacao  butter,  q.s.,  for 
one  suppository. 
SiG. — Two  suppositories  a  day.  The  bismuth 
is    added  to   prevent  irritation  of  the   mucous 
membrane  of  the  rectum. 


lO.O 

2.0 
30.0 
20.0 
500 

aa  0.5 


SJ 


gr.  XXX 

§j.     M. 


recommends 


ijss 
iss 
gr.  iv-v 


gr- 
er. 


i64 


THE  CANADA  MEDICAL  RECORD. 


Tfifi  CAitAtiA  M^t)lCAL  RECORD 


PuBLisuti)  Monthly. 


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EDITORS : 

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London 
F.  WAYLAND  CAMPBELL,  MA  ,  M.D,  LR.CP  ,  London 

ASSISTANT  EDITOR 
ROLLO  CAMPBELL,  CM.,   M.D. 

Make  all  Cliequesor  P.O.  Monty  Onl.TS  for  gubs.'.iiptioii  or 
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tbould  be  addressed. 

All  lett-ers  on  professional  subjects,  books  for  review  and 
exchanges  should  l>e  addressed  to  the  Editor,  Dr.  Lapthorn 
Smith.  248  Bishop  Street. 

Writers  of  original  communications  desiring  reprints  can 
have  them  at  a  trifling  cost,  bv  notifying  JOHN  LOVELL  & 
BON,  imniediatelv  on  the  acceptance  of  their  article  by  the 
Editor. 

MONTREAL,  APEIL,  1895. 


CANADA  MEDICAL  ASSOCIATION. 

From  recent  letters  received  from  one  of  the 
local  officials  of  the  next  meeting  of  the  Canada 
Medical  Association  at  Kingston  at  the  end  of 
August,  as  well  as  from  the  venerable  and 
esteemed  President,  Dr.  William  Bayard,  of  St. 
John,  we  have  every  reason  to  believe  that  the 
Kingston  meeting  of  our  national  Association 
will  be  one  of  the  most  successful  yet  on  re- 
cord. The  time  chosen  for  the  meeting  is  a  most 
convenient  one,  and  every  physician  in  Canada 
should  feel  it  his  duty,  as  well  as  a  pleasure,  to 
be  present.  Of  course  it  entails  financial 
sacrifice  at  the  moment,  but  the  expense  should 
be  looked  upon  as  a  good  investment,  which 
will  bring  in  a  large  dividend,  in  the  shape  of 
increased  health  and  strength,  mentally  and 
physically,  for  the  following  winter's  work. 

The  physicians  of  the  Province  of  Quebec, 
especially,  who  have  no  provincial  society  of 
their  own,  shoul  1  all  the  more  feel  bound  in 
honor  to  attend  the  nalion.il  society  at  King- 
ston, during  the  latter  part  of  August. 

If  each  one  would  hand  in  a  brief  report  of 
a  case  occurring  in  his  practice,  the  success  and 
interest  of  the  meeting  will  be  doubly  assured. 
It  is  a  mistake  which  many  general  practitioners 
make,  in  thinking  that  the  Association  only 
wishes  to  hear  i)rofound  and  learned  disquisi- 
tions on  rare  or  unknown  diseases.  What  seems 
to  please  these  meetings  most  are  papers  full 
of  Hch  fexperience,  or  simply  and  briefly  record- 


ing a  case,  with  i  s  treatment  and  results. 
Most  of  those  who  attend  these  meetings  are 
general  practitioners,  and  what  interests  the 
general  practitioner  generally  interests  the 
whole  meeting. 

THE  INTERNATIONAL  LANGUAGE 
OF  THE  FUTURE 

We  regret  to  see  by  an  editorial  of  one  of 
our  big  New  York  contemporaries,  that  the 
eJitor  speaks  quite  seriously  of  the  advantages 
of  Greek  as  the  universal  language  of  th-e 
future.  While  admitting  that  modern  Greek 
is  a  very  beauiiful,  soft  and  flexible  language, 
yet  the  mere  fact  that  it  is  one  of  the  least 
spoken  languages  of  the  world,  that  is  to  say, 
spoken  by  the  fewest  number  of  the  people  in 
the  world,  renders  it  unsuitable  for  a  universal 
language.  We  have  always  maintained  that,  as 
the  English  language  is  already  spoken  by  the 
vast  majority  of  the  inhabitants  of  the  eacrth"', 
it  would  entail  the  expenditure  of  the  smaHest 
amount  of  energy  if  those  who  do  not  spjak  it 
should  make  a  point  of  becoming  familiar  with 
the  English  language.  The  present  method  of 
having  a  great  number  of  different  languages  to 
express  their  views  in  consumes  an  enormous 
amount  of  energy  among  those  who  are  writers 
of  medical  literature. 

THE   OUTLOOK   FOR    MEDICAL   STU- 
DENTS. 

From  recent  statistics  it  appears  that  the 
supply  of  medical  students  for  the  United 
States  is,  at  the  very  lowest,  three  times  as  great 
as  it  is  in  Great  Britain  or  France.  It  is  no 
wonder  that  medical  men  co;v  plain  of  hard 
times  when  competition  must  necessarily  be  so 
keen.  We  presume  that  a  rather  large  per- 
centage of  American  medical  students  fall  by 
the  wayside,  or,  if  they  graduate,  fail  to  pursue 
their  profession.  It  is  at  best  hard  to  under- 
stand how  Soo  new  members  every  year  can 
earn  a  living.  It  is,  in  fact,  becoming  con- 
stantly harder  for  a  young  medical  man  to  get 
a  foothold.  He  must  either  begin  practice  in 
a  country  village,  or,  if  he  is  desirous  of 
practising  in  the  city,  he  must  have  private 
means  to  enable  him  to  keep  up  a  good  appear- 
ance for  three  or  four  years,  without  his  having 
been  able  to  earn  a  cent. 


THE   CANADA    MEDICAL   RECORD. 


165 


THE  DUTY  OF  NAVAL  SURGEONS. 

Quite  a  little  tempest  in  a  teapot  has  been 
raised  in  naval  and  military  circles  in  the  United 
States  over  the  charges  brought  against  a  naval 
surgeon,  that  while  on  board  his  ship  in  the 
West  Indies,  he  declined. to  take  charge  of  a 
sick  man  on  a  Nova  Scotia  ship,  the  captain  of 
which  had  signalled  to  the  man-of-war  to  send 
its  surgeon  on  board. 

It  is  evident  that  if  the  manof-war  had  not 
been  there  af  the  lime,  no  one  would  have 
thought  of  having  it  sent  there  for  the  purpose 
of  attending  this  sailor  on  the  merchant  ship  ;su 
that  if  the  naval  surgeon  declined  to  take 
his  case  in  hand,  the  sailor  was  no  worse  off 
than  he  was  before  having  met  the  American 
man-ofwar. 

The  naval  surgeon,  in  defending  himself,  said 
that  he  was  employed  by  the  government  to 
attend  to  the  heal  h  of  those  on  board,  and  he 
was  in  no  way  responsible  for  the  health  of  the 
inhabitants  of  another  ship.  The  idea  of 
bringing  a  charge  against  him  for  not  leaving 
his  own  patients  and  taking  the  care  of  a  patient 
about  whom  he  knew  nothing,  and  that  while 
in  the  employ  of  the  United  States  Navy^ 
seems  extremely  absurd. 

THE  NEW  YORK  ACADEMY  OF  MEDI^ 
CINE. 

We  are  pleased  to  see  by  the  treasurer's  re- 
port for  last  year,  that  this  institution  is  in  a 
prosperous  condition,  having  assets  of  nearly 
hilf  a  million  dollars.  The  number  of  resident 
fellows  is  774  ;  the  bureau  for  nurses  has  been 
self-sustaining,  and  added  something  to  the 
treasury.  350  nurses  have  been  registered  and 
180  calls-  for  nurses  have  been    responded  to- 

We  hope  that  the  time  is  not  far  distant  when 
Montreal  will  also  have  its  Academy  of  Medi- 
cine. The  Medico  Chiiurgical  Socieity  alone  has 
a  membership  of  125,  or  about  one-sixth  of  the 
number  ■  of  members  of  the  New  York  Society. 
If  Montreal  had  even  one-sixth  of  that  which  re- 
presents the  assets  of  the  New  York  Society,  it 
would  have  some  $80,000.00.  Could  not  this 
amount  be  raised  among  the  wealthy  merchant 
princes  of  the  city  ?  There  seems  to  be  no  diffi- 
culty in  raising  $!Oo, 000.00  every  now  and  then 
for  various  educational  institutions.  Does  any 
institution  do  more  to  educate  the  medical  pro- 


fession than  the  Medico  Chirurgical  Society  of 
Montreal,  or  is  any  institution  more  deserving 
of  sup]")ort  ? 

We  think  the  time  has  come  now  when  the 
members  should  begin  to  collect  a  fuiid  for  the 
purpose  of  obtaining  a  permanent  home  for  the 
Medico-Chirurgical  Society,  worthy  of  its  high- 
class  personnel,  and  worthy  of  the  excellent 
work  which  it  performs. 

The  bureau  for  nurses  is  still  moie  urgently 
needed  in  Montreal  than  the  home  for  the 
Society.  For  at  present,  medical  practitioners 
hav2  the  greatest  dififuculty  in  hunting  around 
for  a  Tiurse,  when  needing  one  in  any  emer- 
gency ;  while,  if  a  bureau  for  nurses  in  connec- 
tion with  the  Medical  Society  were  established,  a 
su[)erintendent,  who  miglit  be  one  of  the  nurses 
themselves,  in  turn  and  without  salary,  might 
always  be  on  hand,  night  and  day,  and  knowing 
from  day  to  day  exactly  which  nurses  were 
disengaged,  she  could  at  once  send  them  a 
message  where  to  go,  by  means  of  a  telephone 
messenger.  We  hope  that  our  influential  con- 
temparary,  the  Montreal  Medical  Journal^ 
will  take  this  matter  up. 

PATEN  I'  MEDICINES. 

During  the  last  year  or  two,  many  a  hard- 
working, struggling  practitioner  must  have  felt 
keenly  the  rivalry  or  the  competiti(  n  of  the 
wealthy  patent  medicine  manufacturer.  While 
the  physician  cannot  say  one  word  in  his  own 
defence,  the  patent  medicine  man  fills  the  daily 
papers  with  column  afer  column  of  certificates, 
real  or  tictiiious,  of  cures  which  his  medicine 
has  worked,  and  even  in  many  cases  the  ph\si- 
cian  is  publicly  held  up  to  contempt.  Many 
of  the  statements  in  these  advertisements  are 
utterly  false,  as  indeed  are  most  of  the  testi- 
monials. The  public  in  general  take  every- 
thing they  see  in  the  papers  for  gospel 
truth,  not  knowing  that  the  man  who  contracts 
for  so  much  space,  at  an  enormous  cost,  is  at 
liberty  to  insert  rnything  he  pleases  in  those 
columns,  without  any  regard  whatever  for  the 
truth.  So  that  we  see  thousands  of  people 
resorting  to  the  drug  store  to  purchase  these 
patent  medicines,  the  value  of  which  has  been 
vouched  for  by  certificates  from  clergymen, 
acting  in  good  faith,  but  unable  to  judge  of  the 
truth   of  their    statements  ;   from  lawyers    and 


1 66 


THE   CANADA   MEDICAL   RECORD. 


literary  men,  the  latter  of  whom,  of  course,  are 
well  paid  for  their  contributions. 

The  family  doctor  feels  still  more  aggrieved 
when  the  patient  whom  he  sends  to  the  drug 
store  to  have  a  prescription  filled  comes  back 
sometimes  without  the  prescription,  but  with  a 
bottle  of  patent  medicine  which  the  storekeeper 
has  told  him  was  much  better  for  his  case. 

We  have  often  thought  that  something  should 
be  done  by  the  profession  to  protect  itself  from 
the  insults  heaped  upon  it  in  the  text  of  these 
advertisements,  but,  according  to  the  New  York 
Medical  Record,  the  sale  of  patent  medicines 
has  reached  its  highest  point,  and  will  gradually 
fall  little  by  little  as  commercial  prosperity 
returns.  He  has  it  on  the  authority  of  the 
ed\tor  of  a  large  daily  paper  that  the  sale  of 
patent  medicines  always  increases  during  hard- 
times,  for  the  simple  reason  that  people  cannot 
afford  to  employ  a  doctor,  or  think  that  it  is 
more  economical  to  prescribe  for  themselves, 
and  thereby  save  a  doctor's  fee.  He  believes 
that  the  great  sale  of  patent  medicines  is  only 
one  indication  of  the  hard  times,  and  as  soon 
as  general  business  revives,  the  people  will 
again  indulge  in  the  luxury  of  medical  advice 
for  minor  ailments. 

We  have  on  more  than  one  occasion  ven- 
tured to  suggest  to  our  readers  that  they  should 
accommodate  their  fees  to  the  requirements  of 
the  times,  and  that  when  every  one  is  more  or 
less  out  of  employment,  or  has  his  wages  cut 
down,  it  will  pay  the  doctor  to  reduce  his  fee 
in  proportion,  and  to  obtain  the  medicine  for 
his  patients  at  the  lowest  possible  price  con. 
sistent  with   quality. 

Another  thing  which  might  be  done  to  dim- 
inish the  injury  done  to  the  profession  by  patent 
medicines  would  be  for  the  physicians  of  a  city 
to  unite  in  patronizing  a  druggist  who  would 
undertake  not  to  keep  any  patent  medicines  or 
proprietary  articles,  or,  in  other  words,  not  to 
dispense  on  his  own  account,  but  to  limit  his 
business  to  the  filling  of  i)hysicians'  prescri])lions 
only. 

MEDICAL  ITEMS. 

Post  Graduate  Course  in  Gynaecology. 

At  the  request  of  a  number  of  practitioners, 
both  in  Montreal  and  in  neighboring  towns,  Dr. 
Lapthorn  Smith  will,  on  the  ist  of  June,  begin 
a   post  graduate  course  on    the  diagnosis    and 


treatment  of  gynaecological  diseases.  Only  a 
very  limited  number  will  be  taken,  so  that  each 
one  may  become  thoroughly  familiar  with  this 
department  of  medicine.  Those  desiring  to 
join  the  class  should  apply  early. 


We  were  sorry  to  learn  that  Dr.  Lockhart 
was  in  poor  health  and  had  been  obliged  to 
relinquish  practice  for  a  time  in  order  to  take 
a  rest  and  to  recuperate  abroad.  Accompanied 
by  his  wife  and  her  sister,  he  left  a  month  ago 
for  a  trip  to  the  Mediterranean,  from  which  we 
are  glad  to  learn  he  is  soon  about  to  return 
much  restored  in  health. 


A  very  successful  entertainment  was  given 
this  month  at  the*Queen's  1  heatre,  in  aid  of 
the  Samaritan  Hospital  for  Women.  Lady 
Aberdeen  came  down  from  Ottawa  to  attend  it, 
and  there  were  present  almost  all  the  leading 
people  of  the  city,  all  the  boxes  as  well  as  every 
seat  in  the  body  of  the  theatre  and  the  balcony 
being  filled.  The  result  financially  was  all  that 
could  be  desired,  the  receipts  amounting  to 
seven  hundred  and  fifty  dollars. 


Dr.  Macphail,  who,  for  some  years,  has  had 
his  office  on  St.  Catherine  street,  has  moved 
into  his  fine  new  residence  on  Peel  street.  The 
Doctor  is  a  general  favorite  with  the  profession, 
and  we  wish  him  many  years  of  health  and 
prosperity  in  his  new  home. 


BOOK  NOTICES. 

Clinical  Gyn.«cology,  Medical  and  Sur- 
gical. For  Students  and  Practitioners. 
By  Eminent  American  Teachers.  Edited 
by  John  M.  Keating,  M.D.,  LL.D.,  and 
by  Henry  C.  Coe,  M.D.,  M.R.C.S.,  Pro- 
fessor of  Gynaecology,  New  York  Poly- 
clinic. Illustrated.  Philadelphia:  J.  15. 
Lippincott  Company. 

This,  the  latest  work  on  gynaecology,  was 
begun  under  the  joint  editorship  of  two  of  our 
most  brilliant  workers  ;  but  before  it  was  very 
far  advanced,  Dr.  Keating  died,  and  the  whole 
of  the  onerous  duties  of  editing  fell  upon  Dr. 
Coe.  That  he  has  had  a  remarkable  success  in 
accomplishing  them  is  evident  from  a  careful 
perusal  of  the  book  which  lies  before  us.  First 
of  all,  it  is  up  to  date,  and  those  who  are  keep- 
ing abreast  of  the  wonderful  advances  in  gynae- 
cology know  what  that  means,  for  books  that 
were  thoroughly  modern  three  or  four  years 
ago  are  already  behind  the  times  now.  The 
next  point  that  impresses  us  is  the  ability  and 
high  standing  of  the  collaborators.     First,  there 


THE   CANADA   MEDICAL   RECORD. 


167 


is  the  introductory  chapter  by  Dr.  Goodell,  who 
has  since  died — a  chapter  which  should  be  read 
and  re-read  by  every  practitioner  of  medicine. 
His  voice  is  hke  that  of  a  prophet  crying  out  in 
the  wilderness,  warning  us   of  the  errors  and 
abuses  into  which   those  who   practise  in   this 
department  are  too   ready  to   fall.     His  great 
motto  is :    attend  to    the  general   health    first 
before  attacking  the  ovaries  or  v/omb  ;  and  lie 
points  out  the  causes  of  diseases  of  women  with 
the  wisdom  of  a  master  brain  and  the  skill  of  a 
master  hand.     Dr.    Goodell  is  dead  and  lias 
gone  to  his  rest,  but  his  words  in  this  beautiful 
introductory  chapter  will  live  after  him.     We 
were  almost  going  to  say  that  it  alone  was  worth 
the  whole  price  of  the  book.     He  warns  us  that 
the  Anglo-Saxon   stock  of  Americans  is  dying 
out,  owing  to  the  avoidance  of  conception  and 
the  production  of  abortion  among   the  belter 
classes,  and  he  shows  how  unhealthy  and   un- 
wholesome is  the  present  education  and  mode 
of  life   of  our  women.     The    article    by  Dis. 
Baker  and  Davenport,  of  Boston,  on  "  Methods 
of  Gynecological  Examination,"  is  one  of  the 
best  of  its  kind  that  we  have  ever  seen,  every 
point   being   richly    illustrated       Dr.    Hunter 
Robb's  article  on  '' Gyucecological  Technique  " 
is  also  very  good,  occupying  some  eighty  pages. 
Then  follows   Dr.  Bache  Emmett's   article  on 
"  Gynaecological  Therapeutics,"  and  Dr.  Mann's 
on  "Traumatic   Lesions  of  the  Vulva,  Vagina 
and  Cervix."     Dr.  Polk  has  an  elaborate  article 
of  one  hundred  pages  on  "  Inflammation  of  the 
Female  Genital  Organs,"    and   Dr.    VVhitridge 
Williams  a  short,  but  entirely  new,  chapter  on 
"  Genital  Tuberculosis,"  about  which  very  little 
has  hitherto  been  known.     Then  follows  a  fine 
article  by  Boldt  on  "  Neoplasms  of  the  Genital 
Tract  as  far  as  the   Uterus,"  while  Dr.   Coe 
himself  contributes  over  a  hundred  pages  on 
"Neoplasms  of  the  Tubes,  Ovaries  and  Broad 
Ligaments."     Dr.  Coe's  article  is    the  gem  of 
the  whole  work,  and  should  be  read  by  every 
one  before  attempting  pelvic  surgery  of  any 
kind.     The   other    articles    by    Lusk^   Jewett, 
Palmer  and  Montgomery  are  all  good.     The 
writers  of  these  chapters   are  all  teachers,  and 
the  result  is  that   all  they  have  to  say  is  of  an 
exceedingly  practical  nature.     In   the  few  in- 
stances in  which  they  tread  upon  each  other's 
ground,  it  is  rather  an  advantage  than  otherwise, 
for  it  gives  one  a  better  idea  of  how  two  different 
men   accomplish   the  same  work.     Altogether, 
we  have  thoroughly  enjoyed  the  reading  of  this 
book,   so  elegantly  written  and   so  profusely 
illustrated  with  nearly  one  thousand  engravings. 
In  this  respect,  as  well  as  in  the  printing,  paper 
and  binding,  the  publishers  have  treated  their 
authors  generously.     The  book  can  be  obtained 
through  Mr.  Renouf,  St.  Catherine  street,  Mon- 
treal. 

Saunders'  New  Aid  Series,     Dose-Book  and 


Manual  of  Prescription-Writing,  with  a  list 
of  the  official  drugs  and  preparations,  and 
also  many  of    the    newer   remedies    now 
frequently  use  3  with  their  doses.     By  E. 
T.  Thornton,  M.D.,  Ph.G. ;  Demonstrator 
of  Therapeutics,  Jefferson  Medical  College 
of  Philadelphia  ;   Acting  Assistant-Surgeon 
United  States    Marine    Hospital   Service. 
Philadelphia:  W.    B,   Saunders,  925  Wal- 
nut street.    1895. 
Tliis  is  a  very  handy  volume,  suitable  fyr  the 
doctor's  oftice  desk,  as  it  contains   in  an  acces- 
sible form  an  immenseamount  of  inf  )rmation  on 
the   dosage  of  drugs,   but  gives  many  valuable 
suggestions  on  prescription  writing.     The  price 
is  $1.25. 

A  Manual  of  Bandaging,  Adapted  for  self- 
instruction.     By  C.  Henri  Leonard,  A.M., 
M.D.     Professor  of  the  Medica!  and  Sur- 
gical   Diseases  of  Women,    and   Clinical 
Gynaecology    in    the    Detroit    College    of 
Medicine.     Sixth  edition,  with  139  engrav- 
ings.    Cloth,   octavo,    189  pages.      Price 
$1.50.     The   Illustrated  Medical  Journal 
Co.,  Publishers,  Detroit,  Mich. 
The  main  feature  for  commendation  of  this 
book  over  other  smiilar  works  is  that  each  illus- 
tration shows  the  direction  of  the  various  turns 
of  the  bandage    with  arrow-heads,    and    each 
turn    is   properly  numbered ;  this  renders    the 
book  a  self-instructor  to  the  reader  of  it,  who 
has  but  to  put  the  various  bandages  about  the 
limbs  of  an  office  companion  a  few  times,  when 
the  "  trick  "  of  its  application  upon  a  patient 
has  been  learned.     It   takes  the  place,  in   this 
way,    of  hospital  drill.     Besides   the    "Roller 
Bandages,"  the  various  ^s  "  Cravats,"  "  Slings," 
"  Tailed,"  "Adhesive"  and  "Plaster"  band- 
ages, and  "  Immovable  Dressings  "  are  given. 
The  book   is  divided  into  sections   treating  of 
"  The  Bandages  of  the  Head,"  of  "  The  Body," 
of  "  The  Upper  Extremity,"  of  "  The  Lower 
Extremity,"  "  Knots,"    "  Strappings,"    "  Com- 
presses" and  "  Poultices  "  with  full  description 
of  making  and  applying  the  same.     There  is  an 
illustration  for  nearly  every  bandage  described. 
It  has  been   recommended  as  a  text-book  in 
various  medical  colleges  and   hospitals  in   this 
country,  and  has  had  two  editiotis  sold  abroad. 
A  medical  student  could  profitably   spend  his 
vacation  evenings  in  mastering  the  application 
of  bandages  by  using  this  book  as  a  guide,  and 
to  a  practitioner  it  would  not  come  amiss. 

Therapeutic  Suggestion  in  Psychopathia 
Sexualis.  (Pathological  Manifestations  of 
the  Sexual  Sense.)  With  especial  refer- 
ences to  Contrary  Sexual  Instincts.  By 
Dr.  A.  von  Schrenck-Nolzing,  Practising 
Physician  in  Munich.  Authorized  Trans- 
lation from  the  German.  By  Charles  Gil- 
bert Chaddock,  M.D.,  Professor  of  Diseases 


1 68 


THE  CANADA  M&DICAL  RECORD. 


of  tlie  Nervous  System,  Marion-Sims  Col- 
lege of  Medicine  ;.  Member  of  the  American 
Medico-Psychological  Association,  Mem- 
ber of  the  St.  Louis  Medical  Society,  At- 
tending Neurologist  to  the  Rebekah 
Hospital,  Fellow  of  the  Chicago  Academy 
of  Medicine,  Corresponding  Member  of 
the  Detroit  Academy  of  MeJicine,  etc. 
One  volume,  royal  octavo,  325  pages, 
extra  cloth  :  $2.50  neit.  Sold  only  by 
subscription  to  the  medical  profession 
only.  Philadelphia:  The  F.  A.  Davis 
Company,  Publishers.  London :  F.  J. 
Rebman. 


PAMPHLETS  RECEIVED. 

Resection  of  the  Kidnev.  By  M.  Stamm, 
M.D.,  Fremont,  Ohio,  Professor  of  Oper- 
ative and  Clinical  Surgery  in  the  Uni- 
versity of  VVooster,  Cleveland,  Ohio.  Read 
before  the  Detroit  Medical  and  Library 
Association.  Reprint  from  Columbus 
Medical  Journal,  September  18,  1894. 

Impressions  of  American  Medical  Scho  ils* 
An  Addr<.ss  delivered  to  the  Medical 
Students  of  Queen's  University,  by  Ken- 
neth N.  Fenwick,  M.A.,  M.D.,  Professor 
of  Gyn?ecolo,^y,  Queen's  University,  King- 
ston, Ont. 

The  Surgical  Treatiment  of  Inguinal 
HERNiA.     Marcy. 


PUBLISHERS  DEPARTMENT. 


LATE  LITERARY  NEWS. 


Rcdyard  Kipling  to  Return   10  India. 

Rudyard  Kipling  will  shortly  return  to  India,  where 
he  will  prepare,  for  The  Cosmopohtan^  twelve  articles 
to  appear  in  the  American  and  English  editions  of  that 
magazine.  India  is  one  of  the  most  interesting  of  coun- 
tries, and  Mr.  Kipling  is  able  to  write  of  it  as  no  one  else. 
His  work  will  be  looked  forward  to  with  world-wide 
Cjxpectation. 

Perhaps  the  most  beautiful  series  of  pictures  ever 
presented  of  the  Rocky  Mountains  will  be  found  in  a 
collection  of  fourteen  original  paintings,  executed  by 
Thomas  Moran  for  the  May  Cosmopolitan.  To  those 
who  have  been  in  the  Rockies,  this  issue  of  The  Cosmo- 
politan will  l)e  a  souvenir  worthy  of  preservation. 
This  iiuml)er  contains  fifty-two  original  drawings,  by 
Thomas  Moran,  Oliver  Herford,  Dan  Beard,  H.  M. 
Eaton,  F.  G.  Attwood,  F.  O.  Small,  F.  Lix,  J.  H. 
Dolph,  and  RosinaEmmett  Sherwood,  besides  six  repro- 
ductions of  famous  recent  works  of  art,  and  forty  other 
interesting  illustrations — ninety-eiglit  in  a'l.  'Ihough 
'1  he  Cosmopolitan  sells  for  but  fifteen  cents,  probably 
no  maga/ine  in  ihe  world  will  present  for  May  so  great 
a  numtjer  of  illustrations  specially  designed  for  its  pages 
by  famous  illustrators.  The  fiction  in  this  number  is  by 
F.  llopkinson  Smith,  Gustav  Kobb6,  W.  Clark  Rugseli, 
Edgar  W.  Nye,  and  T.  C  Crawford. 


A  SPRING-TIMF,  MAGAZINE. 

Women's  colleges  receive  Dr.  Parkhurst's  attention  in 
the  May  Ladies'  Home  yotirnal,  and  the  vigor  with  which 
he  Heats  the  subject  is  unmistakable.  I  lis  words  open 
u[>  new  phases  of  college" training  for  women  which  will 
unquestionably  command  not  only  wide  attention  but 
wide  discussion.  The  fact  that  Florence  Nightingale 
reaches  the  ripe  age  of  seventy-five  this  month  is  made 
the  basis  for  an  interesting  sketch  of  "  The  Angel  of  the 
Crimea,''  as  she  is  to-day,  showing  a  new  portrait  of  her 
and  a  view  of  her  London  home.  Elizabeth  Stuart 
Pheljjs  is  tenderly  reminiscent  of  her  father,  the  late 
Austin  Phelps,  in  the  series  of  "The  Man  Who  Most 
Influenced  Me.''  Edward  Bok  answers,  with  much  force 
and  directness,  a  page  of  "  Problems  of  Young  Men." 
There  is  a  strong  flavor  of  interesting  biography  to  this 
number  of  the  youriial — sketches,  with  portraits,  of  the 
home  lives  and  personalities  of  "  The  Wives  of  Three 
Authors,"  Mrs.  George  W.  Cable,  Mrs.  Conan  Doyle 
and  Mrs.  'I  homas  Hardy,  being  given  on  one  page,  while 
P'rank  S.  Guild  gives  a  sketch  of  the  popular  artist,  A  ice 
Barber  Stephens,  and  Ethel  Mackenzie  McKenna  writes 
of  Marie  Corelli.  John  Kendrick  Bangs  is  irresistibly 
funny  in  his  report  of  the  sixth  meeting  of  "  The  Paradise 
Club."  The  full  score  of  the  "Concert  Mazurka,"  by 
the  well-known  composer,  Bruno  Oscar  Klein,  the  piano 
composition  which  won  the  second  prize  in  xh^  yotintaPs 
musical  series,  is  given.  Exquisitely  illustrated  and 
timely  articles  are  Mrs.  Mallon's  "  Dainty  Commence- 
ment Gown<  "  and  "  The  Silks  of  the  Summer."  Miss 
Hooper  writes  of  "  The  Newest  Dress  Designs,"  and 
Mrs.  Hamilton  Molt  contributes  a  valuable  article  en 
"The  Art  of  TraveUing  Abroad."  Women  who  are 
ordering  their  summer  stationery  will  be  interested  in 
Mrs.  Garrett  Webster's  article  on  "  The  New  Circle  for 
Stationery."  "Ecclesiastical  Embroidery,"  by  Harriet 
Ogden  Morrison,  is  illustrated  from  original  designs. 
The  cover  of  tliis  May  yournal  is  a  reproduction  of  one 
of  Albert  Lyncli's  beautiful  girls,  set  into  an  artistic 
frame.  This  beautiful  magazine  is  sold  at  ten  cents  per 
number  and  at  one  dollar  per  year,  by  the  Curtis  Pub- 
lishing Company,  Philadeli)hia. 


The  four  weekly  issues  of  Littell's  Living  Age  for 
April  are  as  usual  overflowing  with  the  best  things  that 
current  foreign  literature  affords,  and  present  a  wider 
range  of  thought  and  style  than  is  to  be  obtained  in  any 
of  the  montldies,  as  may  be  seen  by  the  partial  table  of 
contents  given  below  : 

"  Some  Recollection;  of  Robert  Louis  Stephenson," 
by  H.  Bellyse  Baildon  ;  "  The  Method  of  Teaching  Lan- 
guages," by  John  Stuart  Blackie  ;  "John  Lyly  and  his 
'  Euphlies,'  "  by  H.  Lacey  ;  "The  Referendum  in  Switzer- 
land," by  Numa  Droz  ;  "Lord  Randolph  Churchill," 
by  Sir  llerl)ert  Maxwell;  "  A  Visit  to  the  Buddhist  and 
Taoist  Monasteries  on  the  Lo  Fau  San,"  by  E.  A.  Irving; 
"  Robeit  Southey,"  by  George  Saintsbury;  "  The  Crisis 
in  Newfoundland,"  by  William  Greswell  ;  "Women  of 
the  French  Revolution,  the  Gre.at  Citoyenne  (Madame 
Roland),"  by  M.  Dale;  "The  Romance  of  a  Stuart 
Princess,"  by  Mrs.  W.  E.  H.  Lecky  ;  "The  Sancho 
Panza  of  Madagascar,''  by  Julian  Corbelt  ;  "Two 
Modern  Poets,"  by  H.  D.  Traill ;  "  Up  the  Yangtsze," 
by  Lise  Boehm,  with  many  other  papers  of  nearly  equal 
value,  besides  poetry  and  ticiion. 

The  fiction  in  tliese  numbers  is  l)y  Charles  Lee,  M.  R. 
Ja\Mes,D.  Sioiiar  Meldrum  and  E.Chilton.  The  authors 
of  poetry  include  Vida  Briss,  Austin  Dobson,  Edith  Rutter, 
J.  A.Coupland,  J.  W.  H.  Crossland,  etc.,etc.  Published 
by  Littell  iSr-Co.,  Boston. 


i 


WM 


Itcifl 


4 


Vol.  XXIII. 


MONTREAL,  MAY,  1895. 


No.  8. 


ORIGINAL  COMMUNICATIONS. 

The  Present  Status  of  the  Electrical 
Treatment  of  Fibroids  169 

Indications  for  Total  Hysterec- 
tomy   170 

SOCIETY  PEOCEEDINGS. 

Montreal  Medico-Chirurgical  Soci- 
ety   178 

Tubercular  Ulceration  of  the  Sto- 
mach   179 

Multiple  Intestinal  Anastomosis  of 
Tubercular  Origin 180 

Tuberculosis  of  one  Suprarenal ISl 

Generalized  Tuberculosis  with  affec- 
tions of  back  of  Tongue,  Soft  Pal- 
ate, Pharynx,  and  first  two  inches 
of  (Esophagus ISl 


Two  Complicated  Breech  Cases  of 
Labor 181 

American  Ellectro-Theraneutic  As- 
sociation   182 

The  Treatment  of  (Toitre 182 

PROGRESS  OF  SCIENCE. 

The  Treatment  of  Sciatica 183 

The  Stomach-Tube  in  Gastric  Affec- 
tions   184 

Recent  Suggestions  in  Therapeutics.  185 
The  Treatment  of  Vomiting  in  Chil- 
dren .   185 

Treatment  of  Placenta  Prsevia 185 

Skin-Graf  ting  of  Stump  after  Ampu- 
tation   187 

Catheterization  of  the  Stomach  and 

Oesophagus ISS 

Class-Room  Notes 188 


EDITORIAL. 

Sir  William  H.  Kingston 189 

The  American  Medical  Association.  189 
The  Kingston  Meeting  of  the  Canada 

Medical  Association 190 

The  Buffalo  Medical  and  Surgical 

.Journal 191 

BOOK  NOTICES. 

Index  of  Medicine 191 

A  Book  of  Detachable  Diet  Lists,.. .  191 
The  Treatment  of  Wounds,  Ulcers 

and  Abscesses 191 

The  Year-Book  of    Treatment  for 

1895 192 

Publishers  Department 192 


Pri^fnal    jlommunications. 


THE    PRESENT  STATUS  OF  THE 

ELECTRICAL  TREATMENT  OF 

FIBROIDS.* 

By  a.  Lapthorn  Smith,  B.A.,  M.D., 
Mintreal,  Canada,  President  of  the  Ameri- 
can Electro-  Therapeutic  Association  ;  Fel- 
lozv  of  the  American  Gynczcological  Soci- 
ety ;  Member  of  the  Royal  College  of  Sur- 
geons, England  ;  Surgeon  in  chief  of  the 
Samaritan  Free  Hospital  for  Women  ; 
GyncEcologist  to  the  Montreal  Dispensary  ; 
Surgeon  to  the  Western  Hospital,  etc. 

At  the  full  flow  of  the  tide  of  the  most 
successful  surgery  the  world  has  ever 
known,  one  must  possess  a  good  deal  of  the 
courage  of  his  convictions  to  rise  in  the 


*  Abstract  of  paper  read  before  the  Obstetrical  and 
Gynsecological  Section  of  the  American  Medical  Associa- 
tion at  Baltimore,  7th  May,  1895. 


presence  of  such  a  distinguished  audience 
as  this,  to  even  discuss,  far  less  to  advocate, 
the  treatment  of  tumors,  even  the  most 
benign  ones,  by  any  other  method  than  the 
surgeon's   knife. 

Appearing  on  the  programme  of  this 
meeting,  surrounded  as  this  paper  and  its 
author  is  by  papers  and  surgeons  advocat- 
ing every  kind  of  surgical  treatment,  from 
tying  the  uterine  arteries  to  removing 
nearly  all  the  pelvic  contents,  my  position 
is  a  peculiarly  difficult  one,  the  more  espe- 
cially as  I  have  been  trained  as  a  surgeon 
and  occupy  the  position  of  surgeon  in  three 
hospitals  where  circumstances  often  compel 
me  to  treat  fibroids  by  surgical  procedure. 
It  is  only  fair  that  I  should  say  at  the 
outset,  that  I  did  not  choose  this  topic  for 
my  discourse  ;  it  was  assigned  to  me  by 
our  esteemed  chairman,  who,  in  order  to 
preserve  the  high  reputation  for  impartiality 
which  should  characterize  the  conduct  of 
the  presiding  officers  of  all  scientific  meet- 
ings, and  which  has  been  possessed  to  an 


I/O 


THE   CANADA   MEDICAL   RECORD. 


eminent  degree  by  the  chairmen  of  this 
section  of  the  Association  in  the  past,  no 
doubt  wished  that  justice  should  be  done 
to  all  methods  of  treatment  at  present 
employed. 

So  strong  is  my  own  personal  taste  for 
surgery,  especially  of  the  abdomen,  that  I 
might  have  been  tempted  to  disobey  the 
chairman's  command,  but  as  I  reflected 
upon  my  work  during  the  past  seven  years, 
there  passed  before  mc  the  image  of  some 
fifty  women  whom  I  had  treated  for  fibroids 
by  electricity.  First,  as  they  appeared  when 
I  saw  them,  with  faces  anxious  with  pain 
and  blanched  with  haemorrhage,  and  then 
after  their  pain  had  been  relieved,  and  their 
bleeding  had  been  stopped  by  galvanism, 
and  their  cheeks  had  resumed  a  rosy  hue, 
these  fifty  women's  faces  encourage  me  to 
do  justice,  though  the  heavens  may  fall,  to 
the  treatment  which  has    cured  them. 

Then  there  pass  before  me  the  dying 
faces  of  ten  women,  who  were  treated  by 
total  extirpation,  at  two  of  which  operations 
I  was  the  executioner,  at  six  of  which  I 
was  the  first  or  second  assistant,  and  at  two 
of  which  I  was  only  a  spectator.  True,  the 
majority  of  the  ten  operations  were  per- 
formed in  the pre-antiseptic  days,  though  by 
a  great  master  in  this  department  of  our 
art ;  but  four  of  them  were  performed 
within  the  last  few  years,  under  the  most 
rigorous  aseptic  precautions,  by  men  who 
have  a  low  mortality  in  general  for  abdom- 
inal surgery. 

'The  memory  of  those  fifty  women  who 
have  been  cured  by  electricity — many  of 
whom  I  could  find  if  required,  and  many 
of  whom  to  this  day  stop  me  in  the  street 
to  thank  me  and  it  for  their  rosy  cheeks — 
and  the  memory  of  these  ten  women  who 
are  now  no  more,  all  tell  me  that  I  would 
be  a  traitor  to  the  cause  of  truth  if  I  re- 
mained silent,  not  only  out  of  season,  but 
in  the  very  hour  when  it  most  needed  to  be 
spoken. 

True,  I  can   quiet  my  conscience  when 


circumstances  compel  me  to  operate,  by  the 
reflexion  that  one  woman  died  while  under 
electrical  treatment,  not  through  electricity, 
but  through  an  error  of  diagnosis  (in  mis- 
taking a  tense  impacted  liquid  tumor  for  a 
fibroid),  which  would  not  have  been  made  if 
the  abdomen  had  been  opened,  or,  in  other 
words,  if  the  treatment  had  been  surgical 
instead  of  electrical.  This  is  the  one  and 
only  case  in  which,  as  far  as  my  experience 
goes,  I  have  ever  had  to  seriously  regret 
the  use  of  electricity.  I  can  still  further 
soothe  my  conscience  when  I  am  compelled 
to  operate,  by  remembering  that  I  have 
operated  on  ten  women,  seven  by  abdom- 
inal hysterectomy,  treating  the  stump  by 
having  it  transfixed  at  the  lower  angle 
of  the  incision,  and  three  by  removal  of 
the  appendages  tying  the  ovarian  arteries 
low  down,  and  of  several  others  treated 
in  the  latter  manner,  at  which  I  was  first 
assistant,  all  of  whom  recovered  and  are 
now  in  good  health. 

When  I  visit  the  city  of  Brotherly  Love, 
where  the  surgeons  have  declared  war  to 
the  knife  upon  the  electrode,  I  am  often 
placed  in  an  awkward  predicament.  When 
I  tell  my  friend,  Dr.  Jos.  Price,  that  I  am 
going  to  spend  a  few  hours  at  the  electrical 
clinic  with  Dr.  Massey,  he  is  "surprised  that 
a  man  of  my  intelligence  can  waste  his 
time  in  such  fiddle-faddling  nonsense,"  and 
it  is  useless  for  me  to  assure  him  that  I 
can  show  him  many  women  in  Canada, 
from  Manitoba  in  the  West  to  New  Bruns- 
wick in  the  East,  who  are  the  picture  of 
health  and  who  have  been  cured  by 
electricity. 

On  the  other  hand,  when  I  tell  my  friend 
Dr.  Massey  that  I  am  going  to  spend  the 
morning  with  Dr.  Jos.  Price,  extirpating 
fibroids,  he  looks  with  pity  on  my  blood- 
thirsty taste  and  misguided  energy.  In 
vain  I  tell  him  that  life  is  too  short  to  treat 
all  my  fibroid  cases  by  electricity. 

In  this  somewhat  peculiar  position 
which   I  occupy,  I  have   one  consolation : 


THE   CANADA    MEDICAL    RECORD. 


171 


and  that  is,  or  at  least  I  hope  that  it  will 
be  so,  that  the  conclusions  which  I  shall 
presently  lay  before  you  are  those  of  one 
who  is  entirely  unbiassed  and  non-par- 
tizan,  and  consequently  to  be  accepted,  as 
far  as  they  go,  in  good  faith. 

My  own  opinion  on  the  present  status 
of  electricity  in  the  treatment  of  fibroids 
is  fully  made  up,  and  I  shall  now  endeavor 
to  lay  it   plainly  and  honestly  before  you. 

During  the  last  year  especially,  although 
it  has  been  growing  gradually  for  several 
years,  the  conclusion  has  become  evident 
that  electricity  is  not  suitable  for  every 
kind  of  case  nor  for  every    kind  of  doctor. 

It  is  as  true  to-day  as  it  ever  was,  that 
for  the  cure  of  pain  in  and  bleeding  from 
the  uterus,  the  application  of  the  positive 
pole  of  the  galvanic  current,  properly 
applied  and  of  sufficient  strength  to  the 
uterine  mucous  membrane,  is  in  the  major- 
ity of  cases  effective.  The  percentage  of 
successes  is  greatest  in  those  cases  in  which 
the  fibroid  growth  is  interstitial,  not  quite 
so  great  in  the  cases  of  submucous  growths, 
although  in  several  of  these  cases  a  few 
applications  have  been  followed  by  the 
expulsion  of  the  tumor  from  the  uterine 
cavity.  The  earlier  the  cases  come  under 
treatment  the  more  surely  are  they  cured, 
many  patients  vvith  small  interstitial 
tumors  in  the  anterior  wall  having  been 
cured  hy  me,  and  still  more  under 
the  care  of  others.  So  that  the  plea 
for  the  early  treatment  of  fibroid 
tumors  by  electricity  is  just  as  just  a  one 
as  is  the  early  plea  for  operative  treatment — 
indeed,  it  is  even  more  so.  For  while  we 
can  truthfully  say  that  the  electrical  treat- 
ment, when  undertaken  early,  and  with  a 
correct  diagnosis,  is  at  the  present  day 
entirely  devoid  of  danger,  no  one  can 
truthfully  say  the  same  of  the  treatment 
by  operation.  In  fact,  I  am  sorry  to  say 
that  no  one  knows  what  the  death  rate  of 
the  latter  treatment  stands  at.  Three  of 
the  ten  deaths  which  I  have  above   men- 


tioned have  never  been  reported,  and  six  of 
them  were  only  reported  at  my  urgent 
solicitation.  May  there  not  be  many  other 
similar  cases  ? 

When  a  woman  comes  to  a  doctor  for 
menorrhagia,  and  he  discovers  a  small 
fibroid,  is  he  to  urge  her  to  submit  to  an 
operation  when  he  knows  that  with  the 
greatest  skill  and  care  she  runs  the  risk  of 
dying  from  the  operation,  while  if  let  alone 
the  death  rate  is  not  more  than  one  per 
cer.t,,  while  with  electrical  treatment  the 
risk  is  absolutely  nil  ? 

When  she  tells  me  that  she  will  not  sub- 
mit to  operation,  will  I  assure  her  that  I 
can  do  nothing  for  her,  when  I  carry  in  my 
pocket  the  record  of  fifty  similar  or  worse 
cases  which  have  been  cured  by  electricity  ? 
Surely  that  were  dishonest.  And  yet  the 
temptation  to  operate  in  spite  of  the  dan- 
ger of  surgical  and  the  safety  of  electrical 
treatment  is  very  great ;  too  great  in  some 
cases  for  us  to  resist. 

Ours  is  a  busy  life,  and  there  is  not  one 
of  us  here  who  has  not  often  felt  that  life 
was  far  too  short  to  accomplish  all  the 
good  that  we  would  wish  to  do,  and  for 
the  want  of  a  few  more  hours  in  the  day 
much  work  of  value  to  our  fellow-beings 
must  go   undone. 

With  this  feeling  strong  within  us,  a 
poor  woman  applies  at  the  out-patient 
department  of  our  hospital,  with  a  small 
interstitial  fibroid  which  has,  however, 
doubled  or  trebled  the  bleeding  surface  of 
the  uterine  mucous  membrane.  We  believe 
that  we  could  cure  her  by  a  long  and  tedi- 
ous course  of  treatment  with  electricity, 
from  ten  to  fifty  applications,  either  at  the 
hospital,  or  if  there  are  no  facilities  at  the 
hospital,  then  at  our  office.  If  atthe  hospital* 
the  time  required  for  this  one  case  would 
seriously  encroach  upon  the  time  allotted 
to  our  service  there  ;  if  at  our  office,  there  is 
the  same  as  well  as  other  objections. 
And  when  we  have  made  the  sacrifice  and 
cured  the  woman,   what    is  our   reward  ? 


172 


THE   CANADA   MEDICAL  RECORD. 


Perhaps,  but  not  always,  the  woman's 
thanks.  Our  own  feeling  of  having  done 
well,  surely.  But  when  we  turn  to  our 
brethren,  whose  esteem  is  and  should  be 
the  greatest  incentive  that  we  can  look 
for  to  good  work  well  and  conscientiously 
performed,  what  do  they  say?  We  have 
no  fresh  and  bleeding  tumor  to  take  to  the 
medical  society, — as  an  Indian  waves  a 
white  man's  scalp, — before  our  admiring 
brethren  as  a  trophy  of  our  powers  and 
our  skill.  I  have  shown  the  women  over 
and  over  again  ;  I  have  shown  their 
clothing,  which  had  to  be  taken  in  as  much 
as  seven  inches  owing  to  their  decrease  in 
size  ;  the  women  themselves  have  offered 
to  state  on  oath  that  their  bleeding  had 
been  arrested  and  their  pain  removed,  and 
their  general  health  improved.  How  were 
these  triumphs  of  therapeutic  skill  re- 
ceived ?  With  loud  applause,  you  will  say. 
No,  indeed.  The  praise  bestowed  upon  the 
exhibitor  of  even  an  apparently  healthy  ap- 
pendix, the  removal  of  which  was  followed 
by  the  death  of  the  patient,  is  received 
with  acclamations  wild  in  their  enthusiasm 
when  compared  with  the  manner  in  which 
is  received  the  report  of  a  case  of  cure  by 
electricity.  Indeed,  a  sincere  friend  and 
admirer  in  our  Society  warned  me  privately 
that  my  reputation  was  injured  every  time  I 
showed  a  woman  who  had  been  cured  by  this 
means,  and  he  urged  me  to  show  no 
more.  But  I  must  continue  to  cure  them  by 
that  means  as  far  as  my  time  limit  and 
life  limit  will  allow. 

How  different  when  we  report  an  opera- 
tion, whether  the  patient  lives  or  dies. 
Everybody  seems  pleased,  and  praises  us 
in  proportion  to  the  danger  to  which  our 
patient  has  been  exposed.  But  if  she  dies, 
.here  are  two  at  least  who  must  regret  that 
t  was  performed :  the  patient  and  the 
doctor  ;  and  sometimes  there  are  the  hus 
band  and  the  little  children  who  arc  very 
much  concerned. 
But  how  much  easier  to  take  the  patient 


into  the  hospital,  and  in  a  few  days  per- 
form hysterectomy,  which  we  can  do  in 
a  quarter  of  an  hour  sometimes.  It  is,  as 
the  French  say,"  un  mauvais  quart  d'heure," 
but  it  is  soon  over,  and  the  patient's  fate  is 
sealed  for  weal  or  woe  when  we  have  put 
in  the  stitch  which  closes  the  peritoneal 
cavity.  After  that  the  house  surgeon  and 
nurses  take  care  of  her,  and  an  average  of 
three  minutes  a  day  for  the  next  twenty 
days  is  the  very  most  she  requires  of  us. 
But  with  the  electrical  treatment,  what  with 
getting  the  patient  ready,  carrying  out  the 
asepsis  of  the  vagina,  and  adjusting  the 
apparatus,  I  have  spent  as  much  as  one 
hundred  precious  hours  on  one  single 
fibroid  case.  But  the  ovaries  remained,  and 
many  of  these  ladies  are  now  happy 
mothers  of  children,  and  others  are  happy 
wives  though  childless. 

I  have  lately  asked  several  well-known 
men,  men  of  the  highest  surgical  reputation^ 
— you  would  be  astonished  if- 1  mentioned 
their  names, — whether  they  had  employed 
the  electrical  treatment  with  good  results. 
And  when  they  assured  me  that  they  had, 
although  they  have  never  reported  them, 
and  I  asked  them  what  was  the  principal 
objection  to  it,  they  replied  in  confidence 
that  it  took  too  much  of  their  time.  And 
this  I  admit  is  a  serious  objection  to  it,  but 
not  an  insurmountable  one.  There  are  two 
ways  in  which  it  may  be  surmounted  : 
one  is  by  having  an  assistant,  whose  time 
is  less  precious  than  our  own,  who  has  been 
trained  to  carry  out  the  treatment  with 
accuracy  and  care  when  we  prescribe  for  the 
disease  which  our  more  experienced  touch 
has  diagnosed  ;  and  the  other  is  by  having 
several  rooms,  and  a  nurse  to  prepare  the 
patient,  including  the  antiseptic  vaginal 
douche,  and  by  devoting  two  afternoons  a 
A\  eek,  and  having  those  patients  come  only 
at  that  hour,  as  many  as  six  treatments  an 
hour  might  be  administered. 

Never  before  has  it  been  so  well  demon- 
strated as  it  is  to-day,  that  by  the  division 


THE   CANADA   MEDICAL   RECORD. 


173 


and  sLidivision  of  labor  the  artists  become 
more  and  more  expert.  It  does  not  surprise 
me  therefore  that  the  best  results  of  the 
electrical  treatment  of  fibroids  is  obtained 
by  such  men  as  ApostoH  and  Massey  who 
employ  this  treatment  alone.  They  both 
obtain  results  which  neither  I  nor  any  other 
operating  gynaecologist  can  hope  for.  In 
every  large  city  we  should  encourage  some 
one  man  to  establish  an  electro  therapeutic 
clinic,  where  our  poor  patients  at  least  might 
obtain  the  benefit  of  his  skill  in  electrical 
technique  after  having  obtained  the  benefit 
of  our  experienced  diagnosis.  In  time  his 
reputation  would  reach  the  ears  of  the  rich, 
and  he  would  then  have  some  substantial 
reward. 

The  present  status  of  electricity  is  suffer- 
ing, as  did  the  status  of  abdominal  surgery 
a  few  years  ago,  because  they  have  been 
tried  by  men  without  sufficient  experience, 
and  have,  as  a  consequence,  been  found 
wanting.  The  electrical  treatment  of  fi- 
broids requires  the  gynaecologist's  knowledge 
of  the  pelvis  and  its  contents,  as  well  as  the 
electrician's  knowledge  of  the  power  he  is 
wielding. 

I  must  trespass  on  your  time  yet  a  little 
more  while  I  refer  to  two  points :  one,  a 
claim  which  has  recently  been  made  by 
Apostoli  for  the  electrical  treatment,  which  I 
can  heartily  endorse  ;  and  the  other,  an  ob- 
jection which  has  been  made  to  it,  which  I 
can  as  heartily  deny, 

Apostoli  has  discovered  that  the  very 
failures  of  electricity  can  be  turned  to  ad- 
vantage in  the  following  manner :  It  has 
been  found  that  in  those  cases  where  the 
electrical  treatment  has  been  badly  borne, 
and  has  been  followed  by  febrile  reacti-^n, 
so  that  the  patients  have  been  turned  '  /er 
to  the  surgeon  for  operation,  the  presence 
of  pus  tubes  and  pelvic  peritonitis  has  been 
discovered.  Apostoli  has  pointed  out  that 
electricity  may  be  employed  as  a  diagnos- 
tic agent  for  the  purpose  of  detecting  dis- 
eased appendages.     A  remarkable  instance 


of  this  came  under  my  notice  a  little  over 
a  year  ago.  A  young  woman,  who  had  been 
employed   in  a  restaurant   in  a  New   Eng- 
land town,  gradually  lost  her  health  with 
pain  and  hemorrhage.     She  suffered  agony 
with  her  periods,  which  came  too  often  and 
lasted  long,  so  that  her  face  was  blanched 
and    haggard.       There    was    no  difficulty 
about  the  diagnosis,  as  the  tumor  was  large, 
round,  symmetrical    and    in    the    median 
line,  extending   up    to  the  umbilicus,  and 
could   be  easily  seen    and  felt  bulging  up 
the    abdominal   wall.     Several    physicians 
in  the  United  States,  her  family  physicians 
in  Montreal,  as  well  as  myself,  all  agreed 
that   it  was  a  fibroid.      One   of  them  had 
tried   electricity  several   times,  but   always 
with   bad   results,  and  so   did    I.      As  she 
was  laid    up  in  bed    for  several   days   each 
time,    I   concluded     that   the    appendages 
were  diseased,  and  after  three  applications 
I    decided   to  stop  and  to  perform  ccelio- 
tomy.       On    opening    the    abdomen    the 
tumor  was  at  once  seen  surrounded  by  ad- 
herent   intestines,  but    it  still    appeared  a 
symmetrically  pear-shaped  fibroid.    I  could 
not,  however,  detect  the  ovaries  and  tubes, 
and  while  digging  around  for  them  I  made 
a  line  of  cleavage,  which  being  followed  up 
I  was  able   to  dissect   out  a  portion  of  the 
tumor,  which  proved  to  be  a  sausage-shaped 
pus  tube,  which   was  delivered    intact,  tied 
and  cut  off.     Then  followed  a  large  cystic 
ovary,  then   the  other  tube    which    broke 
and  inundated  the  field  with  pus,  and  then 
the    other  ovary,  by  which  time  the    sup- 
posed fibroid  was  gone  and  only  a  moder- 
ate sized  uterus  remained.     The  pelvis  was 
carefully    washed     out    and    drained,    the 
patient  made  a  rapid  recovery,  and  is   now 
at  work  and  enjoying   perfect  health.      So 
that  in    this  case  Apostoli's  doctrine,  that 
when  the  application  of  his  method  causes 
febrile  reaction  the  tubes  are  badly  diseased, 
was    fully  borne    out.     Now,  the  objection 
to    electricity  which    has    so    often    been 
made    to  it,  especially  by  one  of  my  most 


174 


THE  CANADA  MEDICAL  RECORD. 


esteemed  friends  in  Philadeli)hia,  that  it 
causes  adhesions,  is  not  true.  I  maintain 
that  one  has  no  right  to  bring  that  charge  : 
1st,  if  fibroids  which  have  never  been 
treated  with  electricity  do  have  adhesions; 
and  2nd,  if  fibroids  which  ]iave  been 
treated  with  electricity  can  be  proved  not 
to  have  become  adherent. 

Now,  I  am  in  a  position  to  prove  both 
of  these  facts.  When  in  Baltimore  I  saw 
the  abdomen  opened  for  fibroid,  but  it  was 
so  adherent  to  everything,  intestines  and 
abdominal  Avails,  that  the  operator,  one  of 
the  ablest  in  the  world,  did  not  consider  it 
possible  even  to  get  the  ovaries  out,  and 
the  abdomen  was  sewed  up.  Now,  this 
case,  the  most  covered  with  adhesions  I 
have  ever  seen,  you  will  say,  had  received 
many  applications  of  electricity,  and  so  I 
thought,  judging  from  these  statements, 
must  have  been  the  case.  But  careful 
enquiry  elicited  the  fact  that  she  had 
never  received  a  single  application  of  elec- 
tricity. But  that  is  only  negative  evidence. 
Let  us  see  about  some    positive  evidence. 

Three  or  four  years  ago  I  treated  a  lady, 
head  mistress  of  a  large  public  school  a 
thousand  miles  away,  for  hemorrhage  and 
pain,  by  means  of  intra-uterine  positive 
galvanism.  She  had  received  one  year's 
leave  of  absence  from  her  important  duties, 
and  the  commissioners  had  advanced  her 
a  year's  salary  in  order  to  regain  her  health, 
she  being  utterly  incapacitated  for  work. 
You  may  imagine  that  she  was  peculiarly 
arkxious  to  get  well,  and  therefore  submit- 
ted to  a  very  rigorous  application  of  the 
treatment  three  times  a  week  with  great 
fortitude,  as  high  as  200  milliampercs 
being  frequently  given  at  a  time.  And 
this  was  not  for  once  or  a  dozen  applica- 
tions, but  for  one  hundred  times,  l^y  this 
time  the  bleeding  and  pain  were  nearly, 
if  not  entirely,  arrested,  and  I  advised  her 
to  complete  the  cure  by  a  few  months  rest 
at  her  old  home  down  by  the  sea  in  New 
Brunswick.      This  she  did,  and  came  back- 


to  me  in  July  with  rosy  cheeks  and  spark- 
ling eyes.  She  and  I  would  have  been 
perfectly  satisfied  with  the  result,  and  I 
should  have  reported  her  among  my  cures, 
had  it  not  been  for  one  thing,  and  that  was 
that  she  asked  me  the  question  :  "  Can  you 
promise  me  that  the  awful  hemorrhages 
will  not  return  after  I  have  gone  to  my 
far  away  home  in  the  West  .^  "  This  I  could 
not  answer  her  affirmatively. 

Her  next  question  was  :  "  Is  there  any 
other  treatment  by  which  you  could  guar- 
antee that  result  1 "  My  reply  w^as  :  "  Yes, 
one  only,  and  that  is  hysterectomy." 

Although  the  operation  was  not  required 
by  her  then  present  condition,  yet  owing 
to  her  financial  situation,  which  would  pre- 
clude her  ever  coming  to  Montreal  again, 
at  her  urgent  request  I  removed  her  uterus. 

Now,  if  the  charges  against  electricity 
have  a  vestige  of  truth  in  them,  I  must 
have  found  the  tumor  covered  with  adhe- 
sions, in  fact,  the  tumor  and  intestines  and 
appendages  must  have  been  one  agglutin- 
ated mass,  requiring  some  hours  of  pa- 
tient toil  to  detach  them,  and  for  this  I 
was  prepared.  But  what  was  my  astonish- 
ment on  opening  the  abdomen  and  screw- 
ing a  corkscrew  into  the  tumor,  to  be  able  to 
lift  it  out  smooth  and  shining  as  the  top  of 
a  bald  man's  head  ;  the  transfixing  of  it 
with  pins  and  circling  it  with  the  serre- 
ncEud  was  the  work  of  a  few  moments, 
and  in  a  minute  more  the  tumor  was  oft". 
I  She  ran  her  five  or  ten  per  cent,  of  risk  of 
death  safely,  and  made  a  splendid  recovery, 
and  was  at  the  head  of  her  school  once 
more  on  the  1st  of  September. 

One  such  case  carries  more  weight  than 
a  thousand  assertions  that  electricity 
causes  adhesions. 

But  I  can  duplicate  it.  A  young  lady, 
who  is  now  a  trusted  nurse  in  a  New  York 
hospital,  came  to  me,  the  first  year  I  used 
this  treatment,  for  hemorrhage  and  pres- 
sure symptoms  caused  by  a  large  fibroid. 
She  improved  so  much,  that  I  decided  that 


THE  CANADA  MEDICAL  RECORD. 


i7S 


she  might  go  home  by  the  time  she  had 
received  fifty  applications.  But  after  the 
last  application  she  began  to  flow  before 
her  time,  and  I  asked  her  to  wait  until  it 
stopped.  It  lasted  17  days,  a  steady  little 
stream  of  dark  blood.  I  became  momen- 
tarily discouraged,  and  advised  operation, 
which  was  accepted,  and  I  handed  her  over 
to  a  more  experienced  operator  than  I 
was  at  that  time,  but  assisted  at  the  opera- 
tion. The  tumor  came  out  without  the 
slightest  difficulty,  and  was  removed  in  the 
same  way  as  the  one  mentioned  above. 
I  examined  it  most  carefully,  and  the  only 
trace  of  an  adhesion  to  be  found  was  a 
spot  about  the  size  of  a  silver  five  cent 
piece  where  the  tumor  had  rubbed  upon 
the  brim  of  the  pelvis  on  the  right  side, 
and  where  she  had  often  complained  of 
pain  before  coming  to  me.  But  there  was 
not  a  sign  of  adhesion  in  the  track  of  the 
electric  current,  nor  anywhere  else,  except 
at  this  one  spot.  The  hemorrhage  was  due 
to  a  tiny  opening  in  a  uterine  sinus  caused 
by  the  end  of  the  electrode. 

I  dislike  electricity  personally,  because  it 
takes  up  my  precious  time ;  but  I  want  it  to 
get  fair  play,  and  not  to  be  blamed  for  sins 
that  are  not  its  own. 

There  is  one  charge,  however,  which  was 
frequently  brought  against  the  electrical 
treatment  of  fibroids,  or  rather  against  a 
method  of  applying  it,  in  the  past,  and 
which  was  well  deserved,  but  which  is  no 
longer  applicable,  because  no  longer  em- 
ployed— I  refer  to  the  method  by  galvano 
puncture. 

The  greatest  claim  for  the  electrical  treat- 
ment of  fibroids  that  can  be  made  for  it  is 
that  it  has  no  mortality,  that  it  is  absolutely 
safe.  If  it  is  not  more  safe  than  any  other 
treatment,  or  in  fact  unless  it  is  absolutely 
free  from  danger,  there  remains  only  one 
advantage  in  its  favor,  namely,  the  saving 
of  the  ovaries.  But  galvano  puncture,  no 
matter  how  performed,  whether  by  the 
vagina    or     through   the    abdominal    wall, 


must  ever  be  a  procedure  fraught  with 
danger,  and  is  to-day  practically  aban- 
doned. If  anyone  still  uses  it,  in  the 
cause  of  the  electrical  treatment  of  fibroids, 
I  beseech  him  to  use  it  no  more.  The 
positive  pole  of  the  galvanic  current  gently 
introduced  into  the  uterus  will  accomplish 
our  object  by  unseen  but  no  less  certain 
means.  It  dries  up  the  juicy  bleeding 
mucous  membrane,  and  by  its  tonic  action 
upon  the  muscular  tissue  through  which 
must  pass  the  vessels  carrying  nourish- 
n;ent  to  the  tumor,  its  blood  supply  is  cut 
off  just  as  surely  as  though  we  tied  the 
ovarian  arteries  which  supply  the  body  of 
the  uterus. 

The  action  of  the  electric  current  as  ap- 
plied to  fibroids  is  threefold.  The  first  is 
not  mysterious  ;  it  is  but  the  arrest  of  cir- 
culation in  dilated  capillaries  by  an  electro- 
chemical cautery.  The  second  is  no  more 
difficult  to  understand  than  the  action  of 
ergot  or  strychnine  ;  it  not  only  tones  up 
the  vaso-motor  system,  making  the  calibre 
of  the  arteries  less,  but  it  calls  into  play 
the  special  and  remarkable  power  which 
the  uterus  possesses  of  controlling  its  own 
circulation  when  it  has  the  strength  to 
contract. 

The  third  effect  of  the  current,  its  electro- 
lytic action,  is,  I  admit,  as  mysterious  as  it 
has  ever  been,  but  not  more  so  than  the 
invariable  absorption  of  syphilitic  gumma- 
tous deposits  following  the  administration 
of  iodide  of  potassium.  Whether  what  we 
call  electrolysis  means  the  actual  breaking 
up  of  an  organic  tissue  into  inorganic 
atoms,  or  whether  it  means,  as  seems  more 
likely  to  me,  that  the  growth  deprived  of 
its  blood  supply  undergoes  fatty  degener- 
ation, and  is  partly  eaten  up  by  phago- 
cytosis stimulated  to  greater  activity  by 
the  trophic  nerves,  no  one  with  a  large  ex- 
perience with  this  subtle  fluid  can  deny 
that  a  uterus  infiltrated  with  and  enlarged 
by  the  deposit  of  fibrous  tissue,  whether 
localized    in    the  form    of  fibroids  or    dif- 


1/6 


THE   CANADA  MEDICAL    RECORD. 


fused  as  in  areolar  hyperplasia,  so  that  the 
sound  will  enter  four  or  five  inches,  will  in- 
variably diminish  in  depth  by  means  of 
electrical  treatment. 

Then  again,  what  is  the  enormously  en- 
larged uterus  after  delivery  but  a  bleeding 
myoma  ?  Does  it  not  stop  bleeding  when 
the  arteries  which  supply  it  with  blood  are 
squeezed  by  its  contracting  walls  ?  Does  it 
not  rapidly  get  smaller  when,  for  the  want 
of  blood  and  exercise,  that  immense  mass 
of  muscular  tissue  silently  undergoes  fatty 
degeneration  and  returns  to  the  blood  from 
whence  it  came  ? 

Wonderful  and  almost  incredible  as  the 
total  disappearance  of  a  fibroid  or  myoma 
may  seem  to  some,  it  is  no  more  mysterious 
than  this  wonderful  process  of  nature  which 
we  call  involution. 

Have  those  who  doubt,  and  even  worse, 
deny  the  power  of  electricity  to  work  a 
change  in  fibroids,  never  reduced  the  size 
and  weight  of  a  uterus  which  nature  had 
failed  to  involute.''  Has  Emmett  never  re- 
duced its  size  by  repairing  a  lacerated 
cervix  ?  Have  Churchill  and  Athill  and 
ten  thousand  others  with  honored  names 
never  reduced  the  quantity  of  tissue  in  the 
uterus  by  the  application  of  iodine  .■'  Have 
not  a  hundred  thousand  others  never  re- 
duced the  weight  of  blood  and  muscle  and 
areolar  tissue  in  the  heavy  uterus  by  means 
of  glycerine  and  hot  water  and  otherthera- 
peutic  measures  ?  Then  why,  in  the  name 
of  reason  and  justice,  will  you  deny  that  an 
agent,  which  we  can  see  blanching  tissues 
before  our  eyes,  and  making  muscles  of 
every  kind  contract,  why  will  you  deny,  I 
say,  that  it  can  diminish  the  blood  supply 
to  and  favor  the  fatty  degeneration  and  ab- 
sorption of  the  fibrous  or  myomatous 
uterus  ? 

Gentlemen,  the  electrical  tteatmcnt  of 
fibroids,  reduced  to  the  above  simple  equa- 
tion, and  stripped  of  all  the  extravagant 
claims  which  were  at  first  made  for  it,  in 
darkness,  but  in  good  faith,  stands  to-day 


upon  a  foundation  so  strong  and  true,  that 
it  will  find  an  honored  place  in  the  treat- 
ment of  fibroids  as  long  as  women  shall 
dread  to  die  by  the  surgeon's  knife,  which 
I  think  will  be  as  long  as  the  world  shall  last. 

INDICATIONS  FOR  TOTAL 
HYSTERECTOMY. 

Ati  abstract  of  a  Paper  read  in  the  Section  of 
Obstetrics  and  Diseases  of  Women  at  the 
Forty-sixth  Annual  Meeting  of  the  Ameri- 
can Medical  Association  held  in  Baltimore^ 
Maryland,  May  8,  1895.  By  AUGUSTUS 
P.  Clarke,  A.M.,  M.D.,  of  Cambridge. 
Mass.,  U.S.A.,  Dean^  and  Professor  of 
Gyncecology  and  Abdomi^ial  Surgery  of 
the  College  of  Physicians  and  Surgeons^ 
Boston,  Mass. 

The  author,  after  making  some  introduc- 
tory remarks  in  reference  to  his  interest  in 
the  work  of  total  hysterectomy,  speaks  of 
a  new  method  of  operating  by  a  vagino- 
abdominal incision.  He  says,  by  the 
advantages  that  may  be  gained  by  this 
method  of  operating  it  is  not  unsafe  to  say 
that  total  hysterectomy  is  indicated  in 
cases  in  which  the  uterus  may  be  in  a 
position  opposite  to  that  of  prolapse,  and 
in  such  a  state  of  immobility,  superinduced 
by  previous  inflammatory  processes  affect- 
ing the  appendages,  as  to  necessitate  for 
relief  operative  interference.  By  the  facility 
with  which  the  whole  organ  can  be  removed 
by  the  operator's  adopting  the  improved 
method  of  technique,  the  danger  usually 
attendant  on  the  carrying  out  of  such 
radical  measures  will  be  greatly  lessened. 
Total  hysterectomy  should  be  had  recourse 
to  in  cases  of  rapidly  growing  interstitial 
fibroids,  or  in  cases  of  large  subperitoneal 
growths  developing  from  a  broad  sessile 
base. 

The  operation  is  indicated  not  only  from 
the  h.xmorrhage  which  they  occasion,  but 
also  from  the  pressure  which  may  take 
place  upon  the  surrounding  parts.     Fibroids 


THE   CANADA   MEDICAL   RECORD. 


■77 


have   a    tendency    to    take    on    malignant 
degenerative  changes. 

The  removal  of  a  fibroid  should  not  be 
deferred  because  it  appears,  or  is  first 
observed,  at  or  near  the  menopause,  for  it  is 
not  infrequent  for  such  a  tumor  to  continue 
to  develop  long  after  the  occurrence  of  that 
period,  and  it  may  assume  all  the  phases 
and  present  all  the  untoward  results  that 
are  attendant  on  one  that  has  had  an  earlier 
beginning.  A  nodular  fibroid  of  a  slower 
growth  should  not  be  regarded  with  uncon- 
cern, for  the  pressure  that  may  be  exerted 
on  the  uterus  or  other  parts  may  be  pro- 
ductive of  most  serious  results.  Uterine 
myomata  in  all  their  various  stages  call  for 
removal  ;  this  should  be  effected  as  early  as 
possible. 

In  certain  cases  the  curette  can  be 
advantageously  employed  ;  if  this  mode  of 
treatment  proves  unsuccessful,total hysterec- 
tomy should  be  the  next  suigical  expedient. 
The  aulhor  makes  mention  of  a  case  of 
multil ocular  fibroid  which  was  not  cured 
until  hysterectomy  was  tried,  though  Hegar's 
method  for  removal  of  the  uterine  appen- 
dages had  been  resorted  to.  Total  hysterec- 
tomy offers  the  best  advantage  for  the 
permanent  relief  of  uterine  adenoma.  The 
malignant  nature  and  unfavorable  tendencies 
of  uterine  sarcoma  are  unquestioned.  The 
presence  of  such  a  growth  calls  for  speedy 
action. 

As  in  the  early  stages  of  cancerous 
disease,  before  the  para-metrian  tissue  has 
become  involved,  so  in  sarcomatous  develop- 
ments partial  removal  of  the  organ  by  a 
supra  vaginal  method  will  prove  inaquedate; 
nothing  less  than  total  ablation  of  the 
uterine  tissue  will  be  sufficient  for  a  cure. 
Carcinomata  and  sarcomata  in  all  of  their 
various  forms  call  for  immediate  and 
thorough  removal ;  this  should  be  done  as 
soon  as  the  diagnosis  of  the  condition  can 
be  made.  Total  h3sterectomy  is  absolutely 
necessary  for  uncontrollable  prolapse  after 
anterior    and  posterior   colporrhaphy    and 


other  plastic  operations  have  been  repeatedly 
tried  but  have  failed  to  produce  permanent 
relief.  In  such  cases  the  vaginal  method 
is  the  operation  to  be  preferred.  Total 
hysterectomy  is  the  only  safe  surgical  ex- 
pedient to  be  adopted  in  cases  of  hacmorr- 
hagic  polypi,  which  present  suspicious 
microscopic  appearances  after  removal,  and 
which  leave  as  a  result  an  enlarged  uterus* 
as  may  be  determined  by  palpation  or  by 
the    sound. 

Total  hysterectomy  is  called  for  in  ectopic 
pregnancy  ;  in  such  cases  the  heemorrhage 
can  be  more  safely  controlled,  and  the 
patient  is  enabled  to  make  a  more  rapid 
recovery  than  when  other  methods  of 
procedure  have  been  adopted.  This 
method  of  treatment  should  be  undertaken 
in  ovarian  abscess,  in  pyosalpinx,  in  old 
inflammation  of  the  appendages,  in  a  post- 
clinical  severed  uterus  which  has  been 
productive  of  pain,  and  has  been  a  source  of 
disablement.  The  operation  should  be 
resorted  to  in  all  suspicious  diseases  of  the 
adnexa,  and  in  cases  of  large  cysts  as  well 
as  in  papillomatous  developments,  in  other- 
wise irremoveable  cysts,  and  in  intra- 
ligamentous fibroids  and  tumors  of  the 
broad  ligament.  Late  experiences  show 
that  total  hysterectomy  can  be  accomplished 
with  as  little  danger  as  may  be  attendant 
on  many  other  important  surgical  measures. 
When  pron^y  performed,  there  is  often 
but  little  ^•^derness  left  about  the  vicinity 
of  the  broad  ligaments.  When  done  in 
ectopic  pregnancy,  in  ovarian  abscess,  in 
pyosalpinx  and  in  purulent  liquifaction  of 
a  uterine  fibroid,  better  drainage  can  be 
established.  On  the  other  hand,  when  the 
uterus  or  a  portion  of  it  is  left,  the  condition 
resulting  is  liable  to  be  followed  with  many 
complications, — with  uterine  catarrh,  malig- 
nant degeneration,  certain  neuroses,  and 
with  other  sequelae  of  a  painful  or  of  a 
clinically  depressing  nature.  Another 
advantage  total  hysterectomy  insures  is 
that  the  posterior  and  anterior  folds  of  the 


1/8 


THE   CANADA   MEDICAL   RECORD. 


pelvic  tissue  can  be  brought  together 
and  united  by  suturing,  so  as  to  secure 
better  results  than  when  other  surgical 
methods  are  employed.  In  bringing  to- 
gether the  folds  after  the  uterus  has  been 
totally  removed,their  margins  can  be  turned 
outward  and  downward  ;  this  arrangement 
of  the  parts  will  thus  practically  invest  the 
operation  with  all  the  advantages  that  can 
be  secured  by  the  choice  of  the  extra-peri- 
toneal   method. 


focUiyi     jproceebtngs. 


MONTREAL  MEDICO-CHIRURGICAL 
SOCIEIY. 

Stated  Meeting  A^ov.  30,  1894. 

G.  P.  GiRDw;)on,  M.D.,  President,  in  the 
Chair. 

Dr.  Lapthorn  SxMITH  strongly  advocated  the 
use  of  anaesthetics,  and  employed  the  A.  C,  E. 
mixture,  giving  the  bottle  to  the  patient,  and 
instructing  her  to  sprinkle  a  few  drops  on  a 
handkerchief  and  inhale  it  as  she  required  it. 
In  this  way  the  patient  never  became  entirely 
unconscious,  and  the  employment  of  the  anaes- 
thetic did  not  necessitate  calling  in  another 
physician.  He  admitted  that  it  prolonged 
labor  and  increased  the  tendency  to  postpar- 
tum haemorrhage,  but  he  felt  no  anxiety  on  this 
score,  while  he  possessed  the  fluid  extract  of 
ergot,  which  he  administered  in  hot  water 
immediately  after  the  birth  of  the  child,  to 
prevent  it.  He  also  believed  strongly  in  quin- 
ine and  strychnia  for  increasing  and  maintaining 
the  tonicity  of  the  uterus.  The  latter  he  gave, 
where  possible,  for  a  month  previous  to   labor. 

Dr.  Proudfoot  referred  to  the  use  of  laud- 
anum in  labor,  it  diminished  pain,  acted  as  a 
strong  tonic  and  prevented  post-partum 
haemorrhage. 

»Dr.  England  endorsed  Dr.  G.  A.  Brown's 
method  of  giving  ergot.  He  thought  that  in 
some  cases  the  drug  was  not  absorbed  by  the 
stomach,  and  therefore  dependence  should  not 
be  placed  solely  upon  it.  Chloroform,  in  his 
experience,  in  suitable  cases  accelerated  rather 
than  delayed  delivery.  He  differed  from  Dr. 
A.  A.  Browne  in  his  method  of  detacliing  a 
retained  placenta,  keeping  the  pulp  of  his  fingers 
towards  the  uterine  wall,  because  he  believed 
there  was  less  danger  of  damaging  it  thus.  As 
a  styptic  he  considered  the  hand  in  the  uterine 
cavity  the  best  means  of  bringing  about  con- 
tractions, and  after  this  injections  of  hot  water. 

Dr.  A.  A.  Browne,  replying  to  Drs.  England 
and  Campbell,  said  that  if  an  adherent  placenta 


were  detached  from  above,  their  method  would 
be  most  convenient.  He,  however,  spoke  of 
detaching  from  below  and  working  upwards, 
in  which  case  he  believed  the  best  way  was  to 
have  the  back  of  the  fingers  towards  the  uterine 
wail  and  the  pulp  towards  substance  of  the 
placenta,  which  was  separated  by  a  to  and  fro 
movement. 

Dr.  J.  C.  Cameron,  in  closing  the  discussion, 
explained  thjt  in  making  the  arrangements  for 
deah'ng  with  the  subject,  different  parts  had 
been  allotted  to  different  speakers,  and  those 
to  whose  lot  it  had  fallen  to  treat  of  the  nervous 
aspect  of  the  subject  had  l)een  unable  to 
attend.  He  had  no  hesitation  in  putting  him- 
self on  record  as  favoring  the  use  of  anaes- 
thetics in  the  latter  part  of  the  second  stage 
when  the  head  was  down  on,  and  bulging,  the 
perineum.  It  then  not  only  relieved  the  pain, 
but  rendered  laceration  less  likely,  He,  how- 
ever, would  only  use  it  to  the  obstetrical 
degree.  Speaking  of  the  employment  of  ergot, 
he  said  his  own  custom  was  to  give  it  after  the 
birth  of  the  placenta  ;  but  he  saw  no  very  great 
objection  to  giving  it  earlier  in  some  cases 
(that  is,  after  the  birth  of  the  child),  especially 
when  al)Sorption  is  thought  to  be  slow.  It  is 
a  good  rule  not  to  give  ergot  until  the  uterus  is 
empty,  or  can  certainly  be  emptied  in  half  an 
hour.  In  regard  to  this  slowness  of  absorption, 
he  thought  we  would  not  hear  so  much  about 
the  worthlessness  of  ergot,  if  more  care  were  to 
be  taken  to  keep  the  patient's  stomach  reason- 
ably empty.  It  is  not  at  allhard  to  understand 
why  the  drug  has  no  effect  in  some  cases,  when 
we  consider  the  mass  of  stuff,  in  the  way  of 
food  and  drink,  with  which  some  patients  load 
themselves  during  labor.  As  a  prophylactic 
against  post-partum  haemorrhage,  there  were 
two  classes  of  cases  in  which  ergot  should 
always  be  given  :  (i)  \\\  precipitate  labor,  where- 
the  uterus  acts  in  an  hysterical  sort  of  way,  the 
uterine  muscle  not  having  attained  its  rythmic 
power,  and  where  relaxation  and  flooding  are 
apt  to  set  in  as  suddenly  and  acutely  as  the 
contractions  did  previously;  {2)  prolonged \o.hox, 
when  the  uterine  muscle  is  apt  to  become  ex- 
hausted, and  the  relaxation  results  from  weak- 
ness. Ifyou  wish  to  be  sure  of  getting  tlie 
full  effect  of  ergot,  it  should  be  given  hypoder- 
raically,  because  when  given  by  the  mouth  its 
action  is  apt  to  be  slow.  Speaking  of  the 
spontaneous  delivery  of  the  placenta,  he  thought 
some  seeming  contradictions  wliicli  liad  arisen 
during  tlie  discussion  might  be  easily  explained 
by  a  consideration  of  a  few  of  the  factors  which 
play  a  part  in  the  act.  When  the  i^lacenta  is  in 
the  upper  part  of  the  uterus,  the  uterine  nuiscle 
or  the  hand  of  the  operator  may  serve  to  force  it 
do\unwards;  but  directly  it  reaches  the  lower 
uterme  segmen  t,  the  action  of  these  forces  is  much 
lessened.  Its  further  progress  depends  then  upon 
gravity,  supplemented  by  the  contraction  of  the 


THE  CANADA  MEDICAL  RECORD. 


179 


voluntary  abdominal  muscles.  It  was  through 
the  action  of  these  last  that  the  cough,  so  favor- 
ably mentioned  by  Dr.  F.  W.  Campbell, 
obtained  its  potency.  So  also  the  abdominal 
binder,  by  strengthening  the  lax  abdominal  wall, 
steadied  the  uterus,  and  allowed  it  to  act  in  a 
direct  line,  hence  increasing  its  expulsive 
powers.  A  uterus  wabbling  about  in  a  lax 
abdomen  could  not  be  acted  on  so  effectually 
by  the  abdominal  muscles,  as  one  that  is 
steadied  and  kept  in  its  proper  place.  Referr- 
ing to  traction  on  the  cord,  he  said,  of  course, 
when  we  are  positive  the  placenta  is  in  the 
vagina,  no  possible  harm  could  arise  from 
gentle  traction  on  the  cord  ;  but  it  is  the 
possibility  of  making  a  mistake  in  this  regard 
that  is  dangerous,  and  he  believed  that  a 
placenta  which  was  still  in  the  uterine  cavity 
might  sometimes  be  erroneously  thought  to  be 
in  the  vagina,  and  the  traction  upon  the  cord 
would  be  a  mischievous  practice.  Of  the 
danger  of  drawing  on  the  cord  while  the  placenta 
was  still  attached  to  the  uterine  wall,  he  need 
not  speak  ;  and  in  no  case  should  any  but  the 
gentlest  traction  ever  be  employed.  As  to  cases 
of  retained  placenta,  he  believed  that  most  of 
our  cases  of  retention  occurred  in  the  early  days 
of  our  practice  ;  and  as  experience  ripens,  they 
become  rarer.  Retention  is  very  often  caused 
by  undue  haste  in  trying  to  expel  the  placenta, 
or  to  improper  manipulation.  Referring  to  the 
method  of  dissecting  off  the  placenta,  it  seemed 
to  him  that  the  one  mentioned  by  Dr.  A.  A. 
Browne  was  the  right  one.  A  careful  dissector 
always  dissected  towards  the  debris,  and  from 
the  tissue  he  wished  to  save,  m  like  manner  a 
careful  obstetrician  should  work  from  the  uterine 
wall  which  he  wants  to  save  towards  the  placenta 
which  he  does  not  care  to  save.  Then  as  to 
the  difficulty  experienced  in  separating  and  re- 
moving the  placenta,  he  believed  it  was  due  to 
the  fact  that  the  operator  did  not  commence  his 
work  in  the  right  place.  He  should  remember 
that  the  line  of  cleavage  is  in  the  decidual 
plane,  and  to  reach  this  it  is  necessary  to  get 
down  to  the  uterine  muscle.  Most  men  com- 
mence the  operation  of  digital  separation  by 
following  the  cord.  This  brought  them,  of 
course,  in  contact  with  the  t'cetal  surface  of  the 
placenta,  and  the  only  way  to  separate  it  easily 
from  this  point  was  to  push  the  fingers  right 
through  it  until  the  uterine  wall  itself  was 
reached,  and  then  commence  the  "  peeling  off" 
process.  It  would  be  better  to  begin  at  the 
edge  of  the  placenta  rather  than  at  the  attach- 
ment of  the  cord,  or  better  still,  to  follow  up 
the  membranes,  which,  it  will  be  remembered, 
were  separated  from  the  lower  uterine  segment 
during  the  first  stage  of  labor.  By  passing  the 
finger  beneath  them,  the  edge  (not  the  centre,  as 
in  the  case  of  following  the  cord)  of  the  placenta 
may  be  reached  in  the  plane  of  natural  cleavage, 
and    then    the    process    of  peeling   off  will    be 


comparatively  easy.     If  these  points  were  kep 
in  mind,   he  believed    the  breaking    up  of  the 
placenta   into  pieces    during  its    removal,  with 
the  consequent  danger  of  leaving  some  bits  be- 
hind, would  not  so  often  occur.     Coming  then 
to  the  expression  of  the  placenta,  and  the  ques- 
tion of  how  long  should    we  wait  before  doing 
so  ?     It   should  be    remembered  %ohy  we   wait. 
We  wait  to  give  the  uterus  time  to  separate  the 
placenta.     To  do    this  requires  pains  ;  and  the 
number  will  depend  on  their  strength.     A  man's 
clinical    experience,  therefore,  upon  feeling  the 
uterus,    should  always    inform    him    where  the 
placenta  is,  and  when  and  how  he  should  inter- 
fere.    Above   all,  manipulation    should  not   be 
applied  to  "  separate  "  the  placenta,  but  to  expel 
it,  unless  the  uterus  is  incapable,  or  the  placenta 
abnormally    adherent.     A  little    thought,  and  a 
thorough   knowledge  of  what  we  are  doing,  was 
all  the  speaker  believed    necessary  to  guide  one 
in  such  cases.     As  to  the  position  of  the  patient 
in  expelling  the  placenta,  he  preferred  the  dorsal ; 
the    lateral  allowed  the  uterus  to  topple    to  one 
side,  and  pressure  cannot  be  applied  so  correctly 
in  the  axis  of  the  pelvis.     The  Crede  method  of 
manipulation  is   by  all  means  tiie  best  method  ; 
but  it  is  not  so  generally  practised  as  one  would 
think ;   many  only  imagine  they   are    using   it, 
while  only  the  few  really  fulfill  all  its  conditions. 
The  fingers  should  be  got  well  behind  and  thumbs 
in  front  of  the  uterus,  grasping  and  compressing 
the  fundus    before  downward  pressure    is  made. 
If  you  simply  press  upon  the  organ,  as  a  whole, 
without    compressing  the    fundus,  you  will  only 
flatten  out    the   fundus    and   fail   to    move  the 
placenta.     Speaking  then  more    particularly   of 
the   membranes,   he    remarked  that  if  they  are 
ruptured  too    early,  separation    from  the    lower 
uterine  segment  does  not  wholly  take  place,  owing 
to  the  dilatation  of  the  cervix  being  completed 
by  the  head  of  the  child  ;  they  are  then  likely  to 
remain   attached  even  after    the  delivery  of   the 
placenta.     In  such  a  case  the  fingers  should  be 
passed  up,    to  separate    them  from  around    the 
internal    os,  taking   care   tliat   all  are    removed. 
In  closing.   Dr.   Cameron  made  an  appeal   for 
gentle   manipulation   of  the    uterus    during   the 
third  stage,   saying  it  was  one  thing  to  support, 
another  to   injure  the   fundus  ;  and   that  a  great 
deal  of  harm  was  often  done  by  rough  handling 
of  the  uterus  and  its  peritoneal  covering. 

Stated  Meet  big,  December  28M,  1894. 

G.   P.  GiRDwooD,  M.D.,  President,  in   the 
Chair. 

Dr.  A.  G.  Morphy  was  elected  an  ordinary 
member. 

Tubercular  Ulceration  of  the  Stomach. — 
Dr.  Adami  exhibited  this  specimen  taken  from 
a  child  of  ten,  born  in  Montreal,  who,  until 
within  three  months  of  her  admission  to  the 
Royal  Victoria  Hospital,  was  in  one  of  the 
charitable  homes  in  the  city. 


i8o 


THE   CANADA   MEDICAL   RECORD. 


At  the  beginning  of  October  she  began  to  be 
depressed,  and  suffered  from  a  violent  attack  of 
abdominal  pain,  wiih  frequent  vomiting  after 
meals.  The  attack  passed  off,  to  recur  again  a 
fortnight  later ;  there  was  a  third  attack  the 
next  week,  and  since  then  there  have  been 
several  others.  A  fortnight  before  admission, 
the  seizures  became  very  frequent  and  violent, 
two  or  three  daily.  The  vomiting  did  not 
recur  after  the  first  attack. 

During  the  last  two  months  the  emaciation 
had  been  most  rapid,  until  upon  admission,  on 
December  7th,  the  little  patient  was  little  more 
than  skin  and  bone.  Ihe  abdomen  was  full 
a;id  slightly  disiended  and  painless  upon 
entrance  into  hospital,  later  there  was  diffuse 
tenderness  upon  palpation.  The  bowels  were 
regular,  but  slightly  loose. 

A  diagnosis  was  made  of  tubercular  perito- 
nitis. It  was  worthy  of  note  that  the  family 
history  in  this  case  was  good.  The  father  had 
died  of  a  "  tumor  in  the  neck,"  the  mother  and 
three  children  were  alive  and  healthy.  While 
in  hospital  the  child  stated  that  a  cow  at  the 
house  had  beconie  sick  some  few  months 
before,  and  at  last  ceased  to  give  milk. 

The  child  became  weaker  and  yet  more  ema- 
ciated, and  died  upon  the  22nd  instant. 

At  the  autopsy,  the  body  presented  the  most 
extreme  emaciation,  with  a  petechial  eruption 
upon  the  lower  part  of  the  thorax  and  upper  half 
of  the  abdomen,  and  upon  examination  pre- 
sented advanced  tuberculosis.  Upon  opening 
the  abdonicn  there  were  abundant  signs  of  dry 
tubercular  peritonitis.  The  omentum  was 
adherent  in  several  places  to  the  walls.  Scat- 
tered through  it  were  several  small  hasmorr- 
hagic  spots  and  occasional  large  tubercles.  In 
the  centre  of  the  hcemorrhagic  spots  miliary 
tubercles  could  frequently  be  detected, 
'i'he  coils  of  the  small  intestines  were  dotted 
over  with  similar  petechias.  In  the  serous  coat 
of  the  stomach  also  were  at  least  four  whitish 
tubercular  masses.  In  the  small  intestines 
were  typical  transverse  tubercular  ulcers  which 
had  broken  down,  exposing  irregularly  the 
muscular  coat.  The  mesenteric  glands  were 
eijlarged  and  caseous,  as  were  also  the  retro- 
peritoneal glands. 

Before  passing  to  the  consideration  of  the 
state  of  the  stomach,  Dr.  Adami  concluded, 
describing  the  general  post-mortem  appear- 
ance. 

Dissecting  out  the  thoracic  duct,  a  tubercu- 
lar mass  was  found  in  its  walls  opposite  to  the 
body  of  the  sixth  dorsal  vertebra. 

The  bronchial  glands  were  found  enlarged, 
and  some  of  them  entirely  caseous.  There 
were  small  cavities,  the  largest  the  size  of  a 
brown  bean,  in  the  upper  lobes  of  both  lungs, 
with  tubercular  broncho-pneumonia,  and  fur- 
ther a  condition  of  fairly  recent  dry  tubercular 
pleurisy,  the  membranous  adhesions  being  not 


pale  and  bloodless,  but  of  a  reddish  color, 
and  removable  with  moderate  ease.  Tuber- 
cles were  present  in  both  visceral  and  parietal 
pleurae. 

There  was  tlien  a  condition  of  advanced  and 
very  2:eneralized  tuberculosis,  which,  from  the 
extremely  caseous  state  of  the  mesenteric 
glands,  he  was  inclined  to  regard  as  having 
first  manifested  itself  in  connection  with  the 
alimentary  tract,  although  it  would  certainly 
be  possible  to  urge  that  the  disease  began  in 
the  lungs.  It  was  easier  to  explain  intestinal 
tubeiculosis  succeeding  pulmonary  than  vice 
versa.  It  must,  however,  be  remembered  that 
in  this  case  the  earliest  symptoms  were  abdom- 
inal. 

The  petechial  eruption  and  haemorrhagic 
condition  of  the  omentum  and  the  serosa  of 
the  small  intestines  gained  an  explanation  by 
the  discovery  of  growths  of  the  pyococcus  aur- 
eus in  cultures,  made  from  the  spleen  and 
other  organs.  There  had  been  secondary 
infection  on  the  day  immediately  preceding 
death. 

Turning  to  the  stomach,  this  was  found  fairly 
full  of  curdled,  milky  matter,  and  upon  exam- 
ination of  the  walls  there  was  found,  as 
shown  by  the  specimen,  a  certain  amount  of 
post-mortem  digestion,  so  that  in  one  place 
the  wall  was  almost  eroded  through.  In  addi- 
tion, in  the  centre  of  the  great  curvature  was 
an  ulcer  13  mm.  in  diameter,  with  raised  and 
irregularly  thickened  edges,  and  with  a  com- 
paratively smooth  base,  formed  of  the  muscu- 
lar coal  of  the  viscus.  The  smoothness  of  the 
base  might  have  caused  doubt  as  to  the  tuber- 
cular nature  of  the  ulcer,  but  that  this  was 
truly  tubercular  was  shown  by  the  fact  that 
corresponding  to  it  in  position  upon  the  serous 
coat  was  an  area  of  confluent  tubercles. 

Tuberculosis  of  the  inner  coats  of  the  sto- 
mach was  a  rare  condition.  Why  this  should 
be  when  the  affection  was  so  common  in  the 
intestines  it  was  difiicult  to  explain,  unless  it 
was  that  the  acid  excretion  of  the  cells  of  the 
mucosa  hindered  the  i)roliferation  of  the 
tubercle  bacilli,  just  as  acids  are  known  to 
hinder  the  growth  of  the  microbes  outside  the 
body.  This  theory  would  help  to  explain  the 
rarity  of  tuberculosis  within  the  brain  substance 
and  in  muscle-tissues,  which  also  are  character- 
ized by  their  active  development  of  acid  sub- 
stances. That  there  was  no  great  lack  of 
production  of  acid  on  the  part  of  the  gastric 
mucosa,  as  a  whole,  in  this  case  was  evidenced 
by  the  i)OSt-mortem  digestion. 

Multifile  I litestinal  Anastomosis  of  Tubercu- 
lar Origin. — The  same  case  exhibited  no  less 
than  four  fistulous  communications  between 
different  portions  of  l!ie  gut.  The  uppermost 
of  these  was  in  the  lower  part  of  the  jejunum 
where  the  opening  passed  between  the  floors  of 
I  two  ulcers   at   points  distant,    the    one    four 


THE   CANADA   MEDICAL   RECORD. 


l8l 


inches  lower  down  the  gut  than  the  other  ;  the 
lowest  was  between  the  lower  end  of  the  ileum 
and  the  first  inch  of  the  ascending  colon.  The 
fistulas  had  occurred  at  regions  where  the 
serous  surfaces  of  ulcerated  areas  had  come 
into  apposition,  and  where  the  extension  of  the 
intlammaiory  process  on  to  the  serosa  had 
apparently  resulted  in  the  formation  of  adhe- 
sions anterior  to  perforation. 

Tuberculosis  of  One  Suprarenal. — Dr. 
Adami  exhibited  this  case  of  chronic  tubercu- 
losis aflecimg  the  left  suprarenal,  the  right 
being  normal.  The  affected  organ  presented  a 
mass  2.5  cm.,  or  roughly  an  inch  in  diameter, 
showing  on  microscopical  examination  a  cen- 
tral very  chronic  and  fibroid  tubercular  growth 
with  areas  of  caseation  and  frequent  giant 
cells. 

The  specimen  was  from  a  case  from  Dr.  Ste- 
wart's wards  at  the  Royal  Victoria  Hospital,  of 
mixed  syphilis  and  tuberculosis  in  an  elderly 
woman,  the  latter  manifesting  itself  also  in  the 
lungs,  where  evidently  it  was  of  old' standing, 
and  in  the  pleura  where  it  was  of  relatively 
recent  advance. 

Within  the  last  eighteen  months  there  had  been 
a  short  discussion  at  one  of  the  meetings  of  this 
Society  concerning  Addison's  disease,  asso- 
ciated with  affection  of  one  suprarenal.  In 
the  present  case,  as  is  most  usual,  unilateral 
disease  of  the  organ  was  associated  with  no 
bronzing  of  the  rkin,  vomiting,  and  progressive 
loss  of  mental  and  bodily  vigor. 

Generalized  Tuberculosis  with  A^ections  of 
Back  of  Tongue,  Soft  Talate,  Pharynx,  and 
first  two  inches  of  (Esophagus. — The  last  spe- 
cimens were  from  a  case  of  extremely  wide- 
spread tuberculosis  in  a  man  of  22  years  of 
age,  who  died  in  Dr.  Stewart's  ward  of  the 
Royal  Victoria  Hospital.  The  larynx,  trachsea, 
pleurfe,  pericardium,  large  and  small  intestines, 
peritoneum,  liver  and  kidneys,  all  showed 
signs  of  the  disease,  and  with  this  was  exten- 
sive ulceration  of  characteristically  tubercular 
nature  in  the  above  more  unusual  positions. 

T^oo  Complicated  Breech  Cases  of  Labor. 
— Dr.  G.  A.  Brown  read  a  paper  on  this 
subject,  as  follows  : 

Two  difficult  breech  cases  of  labor  hav- 
ing occurred  in  my  practice  within  a  short 
space  of  time,  and  having  the  same  complica- 
tion, I  th.ought  I  would  leport  them,  and  at 
the  same  time  say  something  of  the  method  of 
treating  the  complication. 

Ca<-e  I. — Mrs.  B.,  aged  32,  medium-sized 
woman  ;  has  been  fairly  healthy  ;  has  had  two 
children,  the  fii St  was  an  eight  months'  child, 
and  the  second  went  to  full  term.  During  all 
the  time  that  she  carried  her  children  she  com- 
plained of  persistent  vomiting,  and  when 
pregnant  five  years  ago  the  vomiting  was  so 
severe  that  artificial  abortion  was  performed 
for  her  relief.     When  she    became    pregnant 


this  last  time  I  put  her  on  small  doses  of 
chloral  and  bromide,  which  controlled  her 
vomiting,  and  she  had  good  health  after  the 
third  month.  About  one  month  befoie  labor 
she  fell  down -stairs,  which  might  account  for 
the  complication  present  during  labor.  Her 
labor  began  Wednesday,  October  3rd,  at  2 
p.m. ;  pains  were  strong  and  frequent ;  mem- 
branes ruptured  at  4.  At  5  o'clock  I  saw 
patient  and  made  an  examination,  and  found 
the  breech  presenting  in  the  left  dorso-anterior 
position  and  well  down,  almost  touching  the 
perineum.  Fuetal  heart  was  stiong.  From 
5  to  9  o'clock  there  was  no  change  in  the 
position  of  the  breech,  although  the  pains  were 
very  strong  and  frequent.  At  9  o'clock  the 
pains  began  to  grow  weaker,  and  as  there  had 
been  no  advance  of  ihe  foe  us,  I  decided  to 
give  chloroform.  After  the  patient  was  anoes- 
thetized  I  made  an  examination,  and  found  the 
legs  were  extended,  forming  a  wedge  with  the 
arms  and  head.  The  forceps  were  applied  to 
the  breech  several  times  without  moving  it  to 
any  extent,  and  always  ending  in  slipping. 
Traction  by  means  of  a  finger  in  each  groin 
was  made  without  any  result.  I  then  succeed- 
ed ni  introducing  my  hand  in  utero,  and  seized 
the  foot  of  the  anterior  iimb  by  the  instep, 
flexed  the  left  leg  on  the  thigh  by  sweeping  it 
across  to  the  right  side  of  the  child's  chest, 
and  at  the  same  time  rotating  the  knee  out- 
wards and  everting  the  thigh.  The  limb  was 
delivered  by  internal  rotation  of  the  thigh  and 
extension  of  the  leg.  The  foetus  having  turn- 
ed cynotic  at  this  time  I  endeavored  to  deliver 
it  hurriedly,  but  it  seemed  to  be  still  further 
arrested,  and  on  examination  the  arms  were 
found  to  be  extended.  The  posterior  arm 
was  easily  delivered,  but  on  making  traction  on 
the  fcetus  the  anterior  arm  became  locked 
between  the  head  and  the  symphysis  pubis. 
As  the  child  was  dead  and  the  arm  could  not 
be  dislodged,  I  severed  it  from  the  chest  wall, 
and  delivered  by  tying  a  noose  around  it. 
The  head  became  extended  during  my  mani- 
pulations, and  I  had  difficulty  in  causing  flexion 
before  delivering  the  child.  The  time  for 
these  manipulations  was  about  one  hour  and  a 
quarter.  The  patient  made  a  good  recovery. 
Her  temperature  rose  to  100  °  F.  on  the  third 
day  and  fell  to  normal  on  the  sixth. 

Case  2. — Mrs.  F.,  primipara,  age  44,  is  a 
large,  well  developed  woman  ;  has  been  fairly 
healthy,  no  illness  of  any  extent;  has  been 
married  twenty  years  ;  family  history  tuber- 
cular, one  brother  and  sister  having  died  of 
phthisis.  Patient  came  to  me  in  August  com- 
plaining of  an  abdominal  tumor,  which  on 
examination  proved  to  be  pregnancy.  Her 
last  menstrual  period  was  January  20th,  and 
vomiting  did  not  set  in  until  the  end  of  March. 
Felt  life  about  the  end  of  June.  On  October 
1 8th  I  made  an  examination   of  the   patient,  as 


l82 


THE   CANADA   MEDICAL   RECORD. 


she  was  complaining  of  severe  pains  in  the 
abdomen.  The  breech  was  found  presenting 
in  the  left  dorso-antcrior  position.  At  this 
time  no  abnormality  was  discovered.  Pains 
having  ceased  I  did  not  see  patient  until 
November  29th.  She  had  complained  of 
cedema  of  the  legs  and  frequent  micturition 
during  the  intervening  time,  and  two  days  pre- 
vious to  her  labor  had  severe  pains  off  and 
on.  Labor  began  at  2  a.m.  Thursday,  The 
pains  were  good  and  strong  up  to  6  a.m., 
when  I  saw  the  patient  and  made  an  examina- 
tion ;  found  the  os  dilated  to  about  the  size  of 
a  fifiy-cent  piece  and  the  breech  presenting  in 
the  left  dorso-anterior  position.  Fcetal  heart 
normal.  Pains  continued  strong  andfrequent 
up  to  II,  when  they  began  to  grow  weaker 
and  less  often.  On  examination  the  os  re- 
mained about  the  same,  and  there  was  no  ad- 
vance in  the  breech.  Patient  was  feeling 
pretty  well  played  out.  and  complained  of 
severe  headache.  I  decided  to  give  her 
chloroform  and  deliver  the  breech.  Patient 
being  anesthetized,  on  examination  there  was 
found  extension  of  the  legs  forming  a  wedge 
with  the  head  and  arms.  As  in  the  former 
•case,  I  decided  to  introduce  my  hand  and 
break  up  the  wedge.  Ihe  os  being  dilated 
manually,  the  hand  was  with  difficulty  intro- 
duced, and  the  instep  of  the  anterior  limb 
seized  and  the  leg  delivered  as  before.  After 
this  the  arms  were  delivered  before  traction 
was  made  on  the  foetus,  thus  avoiding  the 
accident  which  occurred  in  the  previous 
case.  After  delivery  of  the  arms,  traction  was 
made  without  result,  as  the  foetal  head  was 
arrested  at  the  brim.  I  attempted  to  apply 
forceps,  but  failed,  and  on  bimanual  examina- 
tion the  head  was  found  very  large  and 
fluctuating,  and  the  diagnosis  of  hydrocepha- 
1  is  was  made.  I  then  severed  the  vertebral 
column  in  the  dorsal  region,  and  passed  up  a 
gum-elastic  catheter  to  the  cranial  cavity,  and 
drew  off  one  gallon  of  fluid.  The  foetal  head 
was  then  easily  delivered  by  traction  on  the 
body.  Time  for  manipulations  was  about 
thirty  minutes. 

The  measurements  of  the  foetal  head  were  as 
follows  :— Orcipito-parietal  20)^  inches,  breg- 
matic  21  inches,  occipitomental  21^  inches. 
The  placenta  was  about  3>^  by  4j4  inches,  and 
was  very  soft  and  friable.  About  two  hours 
after  labor,  patient  had  post-puerperal  con- 
vulsions, which  were  very  severe  and  which 
listed  for  three  hours  and  were  controlled  by 
chloroform,  chloral,  bromide  and  a  purge  of 
hydrarg.  subchlor.  with  pulv.  jalap  co.  The 
urine  contained  2  i)er  cent,  of  albumen. 
Patient  made  a  good  recovery.  Lactation 
was  established  on  the  fifth  day,  and  with  it  a 
little  rise  of  temperature,  which  fell  to  normal 
on  the  following  morning.  Albumen  dis- 
appeared on  the  sixth  day. 


As  will  be  seen  by  the  method  adopted  in 
the  second  case,  I  profited  by  the  experience 
gained  by  the  first.  Had  I  followed  this  me- 
thod in  the  first  case,  I  am  sure  I  could  have  deli- 
vered a  living  child.  There  are  several  methods 
of  dealing  with  this  complication  :  First,  for- 
ceps ;  second,  soft  fillet  or  hook  ;  third,  intro- 
duction of  the  liand  up  to  the  fundus,  seizing  a 
foot  and  delivering  it,  thereby  breaking  up  the 
wedge  by  causing  extension  of  the  vertebral 
column. 

Forceps  are  recommended  by  many  good 
authorities,  as  Tarnier,  Lusk,  etc  ;  but  I  think 
that  it  is  a  waste  of  time  to  apply  them,  as  they 
are  fitted  to  the  thin  end  of  the  wedge,  and  in 
nine  cases  out  of  ten  are  bound  to  slip  and  cause 
a  great  deal  of  damage  to  the  maternal  tissues. 
Besides,  traction  cannot  be  made  in  the  right 
direction,  that  is,  usually  to  the  right  or  left  side, 
in  order  to  change  the  flexion  of  the  vertebral 
column  to  extension,  which  is  a  most  important 
thing  in  breaking  up  the  wedge.  Another  dan- 
ger of  repeated  application  of  forceps  is  perhaps 
to  stimulate  the  child  to  breathe  and  cause  its 
death  in  utero. 

The  soft  fillet  is  still  recommended  by  different 
authorities,  but  there  is  often  great  difficulty  in 
applying  it,  and  it  takes  a  great  deal  of  time, 
and  even  then  one  is  not  always  successful. 
There  is  also  danger  of  lacerating  the  child's 
tissues  and  fracturing  the  femur.  The  third 
metliod  seems  to  me  to  be  the  most  scientific, 
and  is  therefore  the  best,  as  it  breaks  up  the 
wedge,  is  quickly  performed,  and  causes  less 
damage  to  the  foetus  and  maternal  soft  parts. 
If  one  should  fail  to  introduce  his  hand  owing 
to  contraction  of  the  pelvis  or  tetanic  spasm  of 
the  lower  uterine  segment,  I  think  that  the 
soft  fillet  would  be  the  best  and  surest  method 
of  delivery. 

The  second  case  having  had  a  complication 
of  hydrocephalus,  the  cause  of  which  is  obscure, 
I  would  suggest  a  possible  explanation  of  this 
case,  and  be  glad  to  have  an  expression  on  this 
subject  from  the  members. 

We  had  here  disease  of  the  mother's  kidneys 
and  of  the  placenta,  which  performs  the  same 
function  in  the  child.  Why  should  not  local 
dropsy  occur  in  the  cranial  cavity  in  the  ciiild, 
just  as  ascites  occurs  without  general  ccdema 
in  the  adult  ?  The  fact  that  the  head  receives 
the  freest  circulation  in  the  ftctus  would  deter- 
mine the  site  of  the  fluid  effusion. 

AMERICAN    ELECTRO-THERAPEUTIC 
ASSOCIATION. 

The  Trkatment  of  Goitre.  —  Dr.  Chas. 
H,  Dickson,  of  Toronto,  stated  that  in  the 
early  stages  of  simple  hypertrophy,  a  current 
of  100  to  150  milliampercs  should  be  given 
for  ten  minutes  at  a  time,  a  clay  electrode 
being  applied  over  the  goitre,  and  a  large  wire- 


THE   CANADA   MEDICAL   RECORD. 


1^3 


gauze  electrode  between  the  shoulders.  When 
puncture  is  resorted  to,  one  should  not  be 
content  with  a  current  of  less  than  50  milliam- 
pdres  applied  for  eight  or  ten  minutes,  and  care 
should  be  taken  to  observe  antisei)tic  precau- 
tions, and  to  see  that  the  portion  of  the  needle 
outside  of  the  capsule  is  thoroughly  insulated. 
In  his  experience,  pure  cystic  goitres  had  proved 
to  be  the  most  amenable  to  treatment.  His 
method  was  to  aspirate  the  contents  of  the  cyst, 
inject  a  hot  solution  of  chloride  of  sodium  (r 
drachm  to  the  ounce — 4  to  31  cubic  centi- 
metres), apply  through  a  trocar  a  current  of 
from  50  to  100  milliamperes  for  ten  minutes, 
and  then  withdraw  the  salt  solution.  It  should 
be  remembered  that  puncture  alone  involves 
some  risk,  and  that  change  of  residence  and 
attention  to  hygiene  are  important  adjuncts  to 
all  forms  of  treatment. 

Dr.  Robert  Newman,  of  New  York,  referred 
to  a  method  of  treatment  employed  by  Dr 
Watkins,  of  New  York  City,  with  good  results 
A  needle  was  connected  with  each  pole  of  the 
battery,  and  currents  of  only  from  }(  io  ^/4  a 
milliampere  were  found  to  answer. 

Dr.  Rockwell  objected  to  the  strong  currents 
advised  by  Dr.  Dickson. 

Dr.  Morton  said  the  object  of  using  these 
strong  currents  was  to  secure  adhesion  of  the 
cyst-walls,  but  the  same  object  could  be  attained 
with  a  current  of  only  5  or  10  milliamperes  by 
calling  to  our  aid  metallic  electrolysis — [/ni- 
versal  Medical  Journal. 


Iro^tcss    of   Science 


THE  TREATMENT  OF  SCIATICA. 

Gr?eme  Hammond,  in  discussing  the  treat- 
ment of  sciatica  in  the  Post-Graduate  for  Sep- 
tember, 1894,  states  that  the  pain  of  sciatica 
varies  in  accordance  with  the  severity  of  the 
disease.  In  mild  cases,  from  10  to  15  grains  of 
phenacetin  will  afford  prompt  relief,  but  in 
the  majority  of  cases  the  ana3sthetic  properties 
of  this  drug  fall  far  below  what  the  patient  re- 
quires. If  the  pain  is  moderately  severe  or 
intense,  it  is  better  to  inject  morphine.  Enough 
morphine  should  be  given  in  one  dose,  if  pos- 
sible, to  thoroughly  arrest  the  pain.  It  has 
been  claimed  that  the  morphine  should  be  i 
injected  directly  into  the  sciatic  nerve,  because 
it  not  only  relieves  pain,  but  also  exerts  a 
beneficial  effect  upon  the  inflammatory  process. 
There  is  no  proof  that  morphine  possesses 
any  such  power.  The  writer  has  injected  it 
repeatedly  into  the  sciatic  nerve  in  many  cases, 
but  never  observed  that  it  had  any  antiphlogistic 
properties.     Puncturing  the  sheath  of  the  nerve 


in  a  number  of  places  by  piercing  it  with  a 
needle  has  in  some  instances  afforded  relief. 
This  is  accomplished  by  permitting  the  serum 
which  is  poured  out  between  the  sheath  and 
the  nerve  to  escape  through  the  puncture  made 
by  the  needle,  thus  relieving  the  pressure  and 
consequently  the  pain. 

Having  made  the  patient  comfortable,  the 
neuritis  is  best  treated  in  the  following  manner  : 
Absolute  rest  of  the  afflicted  leg  cannot  be  too 
strongly  advocated.  Mild  cases  of  sciatica 
sometimes  get  well  in  spite  of  this  rule  being 
flagrantly  violated,  but  the  course  of  every  case 
will  be  shortened,  and,  in  many  instances,  the 
disease  will  be  prevented  from  becoming 
chronic  by  the  rule  of  absolute  rest  being 
strictly  enforced.  The  patient  should  not  only 
be  confined  to  bed,  but  the  leg  must  be  made 
almost  immovable  by  being  confined  in  a  splint. 
The  author  prefers  the  old-fashioned  hip  splint, 
as  recommended  by  Weir  Mitchell.  A  piece 
of  board  about  three  inches  wide,  and  long 
enough  to  reach  from  the  axilla  to  the  sole  of 
the  foot,  should  be  properly  covered,  and  then 
applied  by  attaching  it  to  the  body  by  a  few 
turns  of  a  bandage,  and  in  the  same  manner  to 
the  leg  from  the  knee  to  the  foot  and  from  the 
knee  to  the  hip. 

Having  thus  secured  almost  perfect  rest  for 
the  inflamed  nerve,  the  next  most  important 
feature  of  the  treatment  is  the  application  of 
heat.  The  most  common  seat  of  the  neuritis 
is  in  the  upper  part  of  the  nerve,  from  its  exit 
from  the  pelvis  to  the  middle  third  of  the  thigh. 
Hot-water  bags  should,  therefore,  be  placed 
under  the  back  of  the  thigh  and  kept  there 
continuously  until  all  signs  of  inflammation 
have  ceased ;  the  constant  electric  current  is 
also  very  serviceable  in  relieving  pain.  In 
almost  all  cases  patients  will  speak  of  the  im- 
provement they  feel  after  each  application.  A 
large  electrode,  fully  the  size  of  the  foot,  should 
be  fastened  to  the  sole  of  the  foot  by  straps  or 
elastic  bands.  Another  large  electrode,  fully 
six  inches  square,  should  be  placed  under  the 
hip  while  the  patient  is  reclining.  This  elec- 
trode should  be  connected  with  the  positive 
pole,  the  one  on  the  foot  with  the  negative 
pole,  and  the  current  should  then  be  gradually 
turned  on,  being  careful  not  to  break  the  circuit 
until  the  patient  is  receiving  enough  to  give 
rise  to  a  moderate  sensation  of  burning.  The 
current  may  then  be  allowed  to  flow  uninter- 
ruptedly for  about  five  minutes,  and  should  be 
gradually  diminished  until  it  is  taken  off  entirely. 
This  ought  to  be  repeated  daily,  and  in  severe 
cases  it  can  be  used  advantageously  twice  a 
day.  By  these  three  methods — absolute  rest, 
continuous  application  of  heat,  and  daily  appli- 
cations of  galvanism — the  most  severe  acute 
cases  will  promptly  yield,  the  average  cases  not 
lasting  longer  than  seven  or  eight  days  .  At  the 
end  of  that  time  treatment  can  be  discontinued, 


1 84 


THE  CANADA  MEDICAL  RECORD. 


but  the  patient  should  remain  in  bed  two  or 
three  days  longer.  If,  in  that  time,  he  can 
move  the  leg  without  pain,  he  may  then  be 
allowed  lo  walk  a  little  and  to  gradually  increase 
the  distance  until  further  restriction  becomes 
unnecessary. —  Thcrap.    Gazette. 

THE  STOMACH-TUBE  IN  GASTRIC 
AFFECTIONS. 

In  discussing  the  question  as  to  wliat  can  be 
done  V  ithout  the  use  of  the  stomach-tube  in  the 
diagnosis  and  treatment  of  g  istric  diseases,  A. 
L.  Benedict,  of  Buffalo,  pronounces  the  tube 
as  practically  useless  for  determining  the  motion 
as  well  as  the  sensation  and  absorption  of  the 
stomach,  except  that  the  chemical  examination 
of  the  stomach-contents  assists  in  determining 
the  motor  and  absorptive  power.  It  is  in 
investigating  the  secretions  and  the  course  of 
digestion  that  the  tube  becomes  important,  being 
the  least  distasteful  and  most  practical  of  any 
method  suggested.  Still,  in  weak  patients  with 
irritable  stomachs,  who  vomit  frequently,  the 
stomach-contents  accidentally  furnished  maybe 
made  use  of  and  the  tube  avoided.  The  question 
as  to  whether  the  fats  and  carbohydrates  are 
innocuous  or  whether  they  are  fermenting  is 
answered  unfavorably  by  finding  bacteria  and 
yeasts  microscopically,  and  butyric  and  acetic 
acids  chemically,  in  the  stomach  contents.  But, 
knowing  that  fatty  and  starchy  substances  have 
been  taken,  that  certain  foods  of  these  classes 
habitually  cause  trouble,  finding  the  stomach 
tympanitic  with  gas,  and  noting  the  eructation 
of  sour  gas  or  liquid,  in  which  we  may  smell 
butyric  and  acetic  acids,  the  diagnosis  of  fer- 
mentation is  quite  as  well  established. 

The  change  of  cooked  starch  into  sugar  is  not 
in  itself  an  important  one.  If  the  pancreas  can 
provide  for  any  reasonable  quantity  of  raw 
starch,  it  will  probably  not  be  overtaxed  if  the 
salivary  function  also  devolve  upon  it.  If  the 
saliva  is  suspected  of  being  at  fault  (which  is 
rarely  the  case),  let  the  patient  chew  a  bit  of 
raw  potato  and  spit  into  a  test-tube,  in  which, 
after  a  few  minutes,  the  ordinary  sugar- test  will 
show  whether  or  not  enough  ptyalin  is  secreted. 

'^t   has    been    shown    that   the    presence    or 
absence  of  pepsin  and  rennet  has    not  much 
practical  importance,  a  little  of  either  seeming 
to    act   as  well    as   a  good  deal.     The  author 
protests  against  the  indiscriminate  use  of  pepsin, 
and  believes  that,  as  Ewald  says,  it  .should    be 
restricted  to  cases  of  advanced  mucous  catarrh 
and   atrophy.     The  most   important  fact  to  be 
determined  is  the  quantity  of  hydrochloric  acid. 
Gastritis  of  all  grades,  carcinoma,  and  usually 
dilatation  are  marked  by  a  downward  tendency  ' 
in    the   secretion    of   this    acid ;    uU  crs,    by  a 
marked    increase.     So   far  as  gastritis    is  con-  ; 
cerned,    the    stomach-lube    is    clearly   contra-  ■ 
indicated.  i 


Subacute  gastritis  can  scarcely  ever  require 
the  lube,  either  for  diagnosis  or  treatment, 
unless  it  is  excited  by  foul,  fermenting,  soft 
masses.  Chronic  gastritis  can  usually  be  diag- 
nosed from  the  state  of  the  circulation  and  the 
history  of  the  case;  "still,  the  tube  is  desirable 
in  order  to  verify  the  diagnosis,  and  is  invalu- 
able for  treatment.  Copious  hot  alkaline  drinks 
taken  before  meals  are  of  some  service  in 
stimulating  the  sluggibh  circulation  and  washing 
away  the  tenacious  mucus  which  dams  up  the 
feeble  secretion  of  the  glands,  but  one  experience 
with  lavage  will  teach  us  that  the  stomach  must 
be  filled  and  emptied  several  times  before  it  is 
properly  cleansed. 

Dilaiation  of  the  stomach  can  be  diagnosed 
without  the  aid  of  the  tube,  althoi;gh  the  altern- 
ation of  tympany  and  flatness  and  the  metallic 
tinkle  of  bubbles  bursting  in  the  half-filled 
stomach  are  valuable  tests,  possibly  only  when 
the  tube  is  used.  In  the  treatment,  the  tube  is 
almost  indispensable  to  relieve  the  concomitant 
catarrh  and  to  remove  undigested  remnants  of 
food.  Still,  much  good  may  be  accomplished 
by  giving  predigested  foods  and  antiseptics. 

In  cancer,  the  continued  absence  of  hydro- 
chloric acid,  as  determined  from  the  analysis  of 
the  gastric  contents,  is  diagnostic  but  not 
pathognomonic,  as  was  at  first  claimed.  Few 
cases  of  cancer  fail  to  present  other  indications 
of  their  nature,  and,  v/iihout  confirmatory 
evidence,  the  non-acidity  would  scarcely  warrant 
a  positive  diagnosis.  There  are  cases,  however, 
in  which  every  hint  as  to  the  true  condition 
mu-t  be  eagerly  sought.  All  treatment,  except 
possibly  operative,  is  palliative,  yet  the  tube  is 
useful  for  the  treatment  of  the  accompanying 
catarrh  and  fermentation.  However,  there 
comes  a  time  when  any  mechanical  interference 
is  dangerous. 

As  regards  subacidity  or,  occasionally,  non- 
acidity,  loosely  termed  atonic  dyspepsia,  it  must 
be  borne  in  mind  that,  although  80  or  90  per 
cent,  of  the  cases  will  be  relieved  by  ihe  adminis- 
tration of  hydroch'oric  acid,  there  is  danger,  in 
the  10  or  20  per  cent,  of  cases  remaining,  of 
giving  inappropriate  treatment  unless  the 
stomach-contents  be  examined.  Acid  neurosis, 
or  supersecretion  of  hydrochloric  acid,  may  be 
suspected  from  the  occurrence  of  dyspepsia  in 
a  neurotic  individual,  from  the  account  of  sharp 
gastric  pain  temporarily  relieved  by  taking  food, 
from  highly-acid  eructations,  and  from  the 
general  characteristics  of  a  state  of  over-excite- 
ment rather  than  depression  of  an  organ.  Still, 
the  diagnosis  needs  the  confirmation  of  chemical 
examination.  The  same  neurosis  culminates  in 
peptic  ulcer.  The  occurrence  of  a  large  h;\2mor- 
rhage  scarcely  needs  the  assistance  of  the  tube 
lo  establish  the  diagnosis,  and  the  treatment 
bot^i  of  the  neurosis  and  of  the  otganic  lesion 
consists  of  physiological  rest  of  the  stomach  and 
remedies    lo  calm    the  overwrought   secretory 


THE   CANADA   MEDICAL   RECORD. 


185 


nerves.     Evvald  refrains  from  introducing  the  j 
tube  in  a'l  cases  of  ulcer  in  which  the  diagnosis 

can  be  made  in  another  way,  the  more  so  since  i 

in  these  cases  the  examination  of  the  stomach-  i 

contents  does  not  establish  the  diagnosis  nor  ' 

aid   in    the    treatment. — Therapeutic    Gazette,  i 

September  15,  1894.  i 

A  CASE  OF  AGGRESSIVE    SURGERY. 

A  most  interesting  case  of  abdominal  section 
for  multiple  gunshot  wound  of  the  intestines, 
with  recovery,  is  described  by  Dr.  M.  L. 
Bennett,  of  Watkins,  N.Y.,  in  the  N.  V. 
Medical  Journal  oilz.u.  19.  This  case  goes 
to  show  that  surgical  triumphs  are  by  no  means 
the  exclusive  prerogative  of  surgeons  living  in 
the  great  centres  of  population  and  surrounded 
by  all  the  facilities  which  the  presence  of  highly 
trained  assistants,  a  full  armamentarium,  and 
nursing  of  a  high  order  place  at  their  disposal. 
The  aggressive  courage  of  a  trained  surgeon  may 
develop  wonders,  whatever  the  surroundings 
may  be,  anJ  the  man  who  keeps  in  touch  with 
the  progress,  with  the  surgical  advance  and  the 
methods  of  the  age,  is  at  a  much  smaller  disad- 
vantage than  is  generally  thought,  even  when  he 
exercises  his  profession  in  villages  and  smaller 
towns.  The  case  we  refer  to  was  that  of  an  Italian 
laborer,  suffering  from  a  bullet  wound  an  inch 
and  a  half  to  the  right  and  a  little  below  the  um- 
bilicus, and  found  by  the  surgeon  lying  on  the 
grass,  with  a  distended  abdomen,  a  quick  and 
feeble  pulse,  and  a  respiration  of  40.  The  patient 
was  sent  home,  a  mile  and  a  half,  and  prepara- 
tions were  made  to  operate  without  loss  of 
time.  As  soon  as  all  aseptic  arrangements 
had  been  made,  and  assistants  procured,  the 
operation  was  begun.  Between  two  and  three 
pints  of  clotted  blood  were  turned  out  of  the 
abdominal  cavity.  Beginning  at  the  descending 
colon,  the  intestines  were  methodically  ex- 
amined. Sixteen  wounds  of  the  intestines, 
located  in  the  caecum,  ileum  and  jejunum  ,were 
found  and  closed  with  Lembert  stitches.  The 
peritoneal  cavity  was  then  carefully  washed  out. 
The  wound  was  closed,  leaving  at  the  lower 
end  an  iodoform  gauze  drain.  The  patient 
quickly  rallied,  and  improved  every  day. 
Twenty  days  after  the  operation  a  pain  in  the 
left  sacral  region  revealed  the  presence  of  the 
bullet,  which  could  be  felt  beneath  the  tissues, 
and  was  removed.  A  month  and  a  half  after 
the  accident  the  patient  was  able  to  resume  his 
occupation  as  a  section  hand  upon  a  railway, 
— a  rather  extraordinarily  short  time  after  such 
an  extensive  operation. — International  Jour,  of 
Surg. 

THE  TREATMENT  OF  VOMITING  IN 
CHILDREN. 
The  Journal  de  Clinique  et  de  Therapeu- 
tique  Infa'itiles  publishes  the  following  direc- 
tions and  formulas  to  be  used  in  the  treatment 
of  vomiting  in  children  ;     Very  young  children 


should  be  made  to  ^  wallow  small  pieces  of  ice 
before  nursing  ;  milk,  diluted  with  a  little  Vals 
or  d'Alet  water,  should  also  be  given.  Before 
the  child  is  nursed,  3  grains  of  bismuth  subni- 
trate  should  be  put  on  its  tongue.  The  diet 
should  be  restricted,  the  milk  sterilized,  and  the 
time  of  nursing  properly  regulated.  For  older 
children,  iced  drinks,  ice,  and  effervescent 
waters  are  recommended.  A  teaspoonful  of 
each  of  the  following  mixtures  is  to  be  mixed 
and  swallowed  while  effervescin;  :  r.  Potassium 
bicarbonate,  30  grains ;  syrup,  4  drachms ; 
water,  i]/^  ounces.  2.  Citric  acid,  30  grains  ; 
syrup  of  citric  acid,  4  drachms;  water,  i^^ 
ounces. 

Fonssagrives  recommends  the  following  : 
Essence  of  cajuput,  from  6  to  12  drops  ;  sugar, 
30  grains.  When  this  is  thoroughly  mixed,  add 
an  ounce  of  syrup  of  Tolu  and  3  ounces  of 
Melissa  water.  From  a  teaspoonful  to  a  table- 
spoonful  of  this  is  to  be  taken  every  hour. 
Huchard  prescribed  75  drops  of  tincture  of 
iodine  and  4  drachms  of  saturated  chloroform 
water,  of  which  from  2  to  6  drops  are  to  be  taken 
in  a  little  sweetened  water. 

For  nervous  children  over  twelve  years  old, 
Ewald  prescribes  cherry-laurel  water,  2 
drachms;  tincture  of  belladonna,  75  drops; 
cocaine  hydrochlorate,  4^  grains ;  morphine 
hydrochlorate,  3  grains.  From  5  to  10  drops 
are  to  be  taken  every  hour.  The  following 
formula  is  recommended  by  Guibourt:  syrup 
of  lemon,  6  drachms;  lemon-juice  and  orange- 
flower  water,  each  4  drachms  ;  linden  water,  2 
ounces  ;  Sydenham's  laudanum,  9  drops  ;  sul- 
phuric ether.  15  drops  ;  potassium  bicarbonate, 
30  grains.  The  bottle  should  be  corked 
immediately,  and  from  a  quarter  to  a  third  of 
the  mixture  is  to  betaken  at  once.  Le  Bariller 
advises  the  use  of  the  ether  spray  over  the 
epigastrium  ;  also  blisters  or  the  actual  cautery 
over  the  same  part. —  A^ew  York  Medical 
Journal,  September  15,  1894. 

Preferable  to  any  of  these  we  have  found  the 
following  mixture,  which  has  proved  efficacious 
in  vomiting  of  nearly  every  variety,  including 
vomiting  of  pregnancy  : 

Cocaine  Hydrochlor gr  i 

Aqu8e  cinnamomi 3  ij 

Sig. — One  teaspoonful  every  half  hour  until 
vomiting  is  stopped. — (Ed.  Can.  Med.  Record. 

TREATMENT  OF  PLACENTA  PREVIA. 

In  an  interesting  article  by  Temple  in  the 
International  Medical  Magazine  for  Se[)tem- 
ber,  1894,  the  following  conclusions  are 
reached  :  In  treating  a  case  of  placenta  prsevia, 
the  very  first  question  that  forces  itself  upon  us 
is  to  decide  as  to  the  advisability  or  otherwise 
of  endeavoring  to  prolong  gestation.  Un- 
doubtedly, in  all  cases  of  labor  it  is  the  duty  of 
the  accoucheur  to  enheavor,  if  possible,  not 
only  to  save  the  mother's  life,  but  also  to  give 


1 86 


THE   CANADA   MEDICAL   RECORD. 


every  chance  to  the  child.     In  all  cases  where 
both  the  mother's  and  child's  life  are  in  danger,  | 
the   author   gives    the  greatest  chance  to  the 
mother,  as  her  life  is  of  far  more  importance  i 
than  that  of  the  unborn   cliild.      The  question   I 
is  one  of  the  greatest  importance,  and  one  that  j 
deserves  the  most  careful  consideration  at  the  i 
hands  of  the  attending  physician.     The  line  of  j 
treatment  best  to  be  adopted  is  not  altogether  i 
a  settled  one  ;  there  are  some  who  advise  the 
immediate  termination  of  the  gestation  on  ac- 
count of  the  real  risk  to  the  mother's  life,  and 
there  are  others  who  advise  temporizing  in  the 
interests  of  the  child. 

No  absolute  hard-and-fast  rule  can  be  laid 
down  ;  each  dose  may  possibly  present  some 
peculiar  feature,  calling  for  some  special  line 
of  treatment.  At  the  same  time  the  weight  of 
evidence  is  in  favor  of  the  lerminat'on  of  the 
gestation  when  the  first  attack  of  hemorrhage, 
especially  if  it  be  a  severe  one,  occurs  before 
the  seventh  month,  for  the  following  reasons  : 

1.  The  supposition  is  in  favor  of  the  placenta 
being  centrally  transplanted  when  the  first  at- 
tack of  flooding  is  severe  and  prior  to  the 
seventh  month. 

2.  The  tendency  of  all  such  cases  is  of  them- 
selves to  end  in  abortion  and  consequent  death 
of  the  child. 

3.  When  the  hemorrhage  occurs,  even  in  the 
latter  half  of  gestation,  the  tendency  is  towards 
abortion.  It  is  estimated  that  only  one-third 
of  all  such  cases  reach  the  end  of  gestation. 

4.  'Ihe  liability  to  a  recurrence  of  the  hem- 
orrhage at  any  moment  is  very  great ;  conse- 
quently the  woman's  life  is  hourly  in  danger. 

These  are  all  weighty  arguments  against  pro- 
longation of  the  gestation.  The  great  fatality 
from  i)lacenta  praivia  is  in  the  occurrence  of 
sudden  severe  hemorihage  in  the  absence  of 
the  physician.  The  first  attack  is  usually  slight, 
but  it  should  be  taken  as  a  serious  warning  to 
us  of  the  possibility  of  the  next  attack  beii.g 
very  severe,  if  not  fatal,  before  assistance  can 
be  got.  The  occurrence  of  hemorrhage  in 
the  early  months  of  gestation  so  reduces  the 
chances  of  saving  the  child's  life  that  its  wel- 
fare ought  not  to  be  considered  at  all  alongside 
that  of  the  mother.  The  wisdom  of  prolonga- 
tion of  gestation  is  open  to  serious  question. 
Should  tlie  first  attack  of  hemorihage  occur 
after  the  viable  period  of  the  child,  then  there 
should  be  no  hesitation  in  the  mind  of  the 
physician  as  to  what  he  should  do  for  his  pa- 
tient, as  he  should  without  doubt  terminate  the 
gestation  as  soon  as  possible.  By  so  doing,  the 
child  and  mother  both  have  a  much  better 
chance  cf  ultimate  recovery.  To  delay  is  to 
increase  both  maternal  and  foetal  mortality. 
On  this  point  tiie  words  of  Robert  Barnes  are 
worth  quoting:  "If  the  pregnancy  have  ad- 
vanced beyond  th*i  seventli  month,  it  will,  as  a 
general  rule,  1  think,  be  wise  to  proceed  to  de- 


livery, for  the  next  hemorrhage  may  be  fatal. 
We  cannot  tell  the  time  or  extent  of  its  occur- 
rence, and  when  it  occurs,  all,  perhaps,  that  we 
shall  have  the  opportunity  of  doing  will  be  to 
regret  that  we  did  not  act  when  we  had  the 
chance." 

These  arc'  very  significant  words  from  a  man 
of  vast  and  varied  experience.  The  few  cases 
where  it  may  be  deemed  advisable  to  prolong 
gestation  in  the  interests  of  the  child  should  pre- 
sent some,  if  not  all,  of  tiie  following  features: 

1.  That  the  woman  be  very  near  the  seventh 
month  of  pregnancy. 

2.  That  the  first  attack  of  hemorrhage  be 
but  a  slight  one. 

3.  That  the  placenta  be  but  laterally  im- 
planted. 

4.  That  the  woman  be  within  easy  reach  of 
medical  assistance. 

Under  such  conditions  the  patient  should  be 
j  put  to  bed,  kept  absolutely  quiet,  free  from  all 
surrounding  excitement,  and  possibly  given  an 
i  occasional  dose  of  opium. 
I  There  is  no  virtue  in  the  so-called  astringents, 
such  as  acetate  of  lead,  gallic  acid,  etc.  The 
j  writer's  own  practice  is  not,  even  under  such 
circumstances,  to  advise  the  attempted  pro- 
;  longation  of  pregnancy ;  the  risks  to  the 
I  mother  are  too  great  and  the  chances  of  saving 
the  child's  life  too  small.  Presuming  the  case 
to  be  one  occurring  after  the  seventh  month, 
the  attack  of  hemorrhage  to  be  a  severe  one, 
and  the  cervix  undilated,  delivery  should  be 
accomplished  as  soon  as  possible.  For  this 
purpose  he  would  advise  that  the  membranes 
be  ruptured  ;  this  allows  the  uterus  to  contract, 
and  will  of  itself  frequently  be  sutticient  to 
check  further  loss  of  blood.  The  objections 
raised  against  this  plan  of  treatment  are  that 
the  normal  means  for  dilating  the  cervix  is  re- 
moved, and  that  the  chances  against  the  child's 
living  are  increased.  Still,  it  is  the  quickest 
way  of  securing  rapid  contraction,  and  thus 
stopping  further  loss  of  blood.  If  the  flooding 
continues  and  the  os  is  not  sufficiently  dilated 
to  admit  of  version  readily,  and  especially  if 
the  patient  is  much  exhausted  and  not  in  a  fit 
state'  to  admit  of  version,  the  next  best  step  is 
to  separate  the  placenta  by  the  finger  from 
around  the  cervix  as  far  as  the  finger  will  reach, 
as  recommended  by  Robert  Barnes.  This,  as 
a  rule,  answers  promptly.  It  checks  the  flood- 
ing and  it  also  favors  dilatation  of  the  cervix, 
for  so  long  as  the  placenta  retains  its  attach- 
ments to  the  lower  zone  of  the  uterus  the  cervix 
will  not  readily  dilute.  The  internal  adminis- 
tration of  ergot  may  be  resorted  to  from  the  first. 
In  the  event  of  these  means  failing,  and  if 
the  flooding  still  continues,  while  the  cervix  is 
sNll  not  dilated  so  as  to  admit  of  version,  plug- 
ging the  vagina  firmly  with  antiseptic  tampons 
should  be  resorted  to.  Before  plugging,  the 
vagina  should  be  carefully  syringed  out  with  an 


THE   CANADA   MEDICAL   RECORD. 


187 


anliseplic  lotion  ;  this  method,  if  properly  ap- 
plied, is  very  efficient.  The  plugs,  however, 
must  be  carefully  inserted,  one  after  another ; 
the  first  one  should  be  placed  within  the  cer- 
vix itself,  and  then  the  others  in  rotation  till 
the  vagina  is  perfectly  full.  The  plugs  may  be 
made  of  clean  strips  of  cotion  or  wool,  pre- 
viously soaked  in  some  antiseptic  solution.  On 
no  occasion  should  a  sponge  be  used  which 
has  been  in  use  in  the  house  for  other  purposes. 
After  the  vagina  has  been  carefully  packed,  a 
firm  pad  should  be  placed  over  the  uterus,  and 
the  whole  kept  in  position  by  a  carefully  ap- 
plied bandage.  The  tampons  should  not  be 
left  in  longer  than  six  or  eight  hours,  and  when 
removed  the  vagina  should  again  besyiiigedout. 

Lastly,  if  on  removal  of  the  plugs  the  os  be 
found  sufficiently  dilated  to  perform  version, 
and  the  woman  herself  be  in  a  fit  state  for  the 
Operation,  it  should  be  done.  The  bipolar 
method  being  used,  if  possible,  the  leg  of  the 
child  when  brought  down  will  both  form  an 
efficient  plug  and  further  assist  in  dilating  the 
cervix.  The  operation  of  version  by  the  bi- 
polar method  may  be  undertaken  at  any  time 
in  the  course  of  the  treatment  whenever  the 
cervix  will  permit  of  it. 

In  Berlin  it  is  claimed  that  by  this  method 
of  treatment  the  mortality  has  been  reduced  to 
four  and  one-half  per  cent,  of  women  and  sixty 
per  cent,  of  children, — a  marvellous  reduction 
as  compared  with  what  it  used  to  be. —  Iher. 
Gazette. 

SKIN-GRAFTING    OF    STUMP    AFTER 
AMPUTATION. 

By  Charles  McBurney,  M.D.,  Professor  of 
Surgery  at  the  College  of  Fhysieians  and 
Surgeons. 

The  case  upon  which  I  will  operate  is  one 
that  requires  skin-grafting  in  order  to  cover  a 
large,  granulating  surface  on  the  arm.  It  is  an 
interesting  one,  because  it  illustrates  the  best 
method  of  treatment  in  a  good  many  cases  of 
traumatic  surgery.  By  means  of  it  we  can  often 
save  large  portions  of  tissue,  which,  treated  ac- 
cording to  ordinary  principles,  would  surely  be 
sacrificed.  Take,  for  instance;  a  case  of  com- 
pound fracture  of  the  thigh,  with  extensive 
laceration  of  the  bone  and  soft  parts .  The  in- 
jury was  inflicted  perhaps  in  a  railroad  accident, 
or  by  heavy  machinery  ;  the  wound  is  filled 
with  coal  dust  or  filth,  and  the  patient  is 
brought  to  the  hospital  in  a  state  of  profo'.md 
shock.  Formerly,  the  approved  method  of 
treating  such  a  case  was  to  get  rid  of  all  the 
septic  material  by  performing  an  immediate 
amputation  above  the  wound.  One  serious 
objection  to  this  is  that,  as  these  patients  are 
usually  suffering  from  shock  and  hemorrhage, 
an  immediate  and  prolonged  operation  often 
proves  fatal.  The  way  in  which  we  have 
treated   quite  a   number  of  such   cases   here, 


among  them  the  one  upon  which  I  am  about 
to  perform  skin-grafting,  is  as  follows  :  If  there 
are  any  bleeding  vessels,  they  should  be 
secured  at  once  ;  then,  with  the  scissors,  any 
shreds  about  the  stump  are  snipped  off,  and 
the  whole  area  cleansed  as  thoroughly  as  pos- 
sible. The  wound  is  left  wide  open — not  a 
single  stitch  being  put  in — and  dressed  with 
sterile  gauze,  just  as  though  you  were  dealing 
with  a  clean  wound  and  expected  primary 
union.  All  this  can  be  done  within  ten  or 
fifteen  minutes,  and  without  the  aid  of  an 
anaesthetic.  These  wounds,  no  matter  how 
dirty  tiiey  are,  if  thoroughly  cleansed  and  kept 
wide  open,  do  very  well  indeed.  Perhaps,  at 
the  end  of  a  month  or  two  —  or  as  soon  as  the 
p;.tient  has  recovered  from  the  effects  of  the 
injury — an  amputation  can  be  performed,  if 
necessary. 

This  patient,  about  six  weeks  ago,  had  his 
left  arm  caught  in  a  cog-wheel,  producing 
great  destruction  of  the  tissues,  and  almost 
severing  the  forearm  about  three  inches  below 
the  elbow  joint.  The  wound  was  treated  very 
much  in  accordance  with  the  principles  above 
laid  down,  and  we  now  have,  as  yoii  see,  a 
fairly  good  stump,  with  au  extensivegranulating 
surface  extending  almost  up  to  the  elbow  joint. 
The  question  now  arises  whether  it  is  better  to 
remove  this  stump,  or  make  an  attempt  to  pre- 
serve it  by  skin-grafting.  Even  such  a  small 
portion  of  the  forearm  as  this  is  of  enormous 
value,  while  if  we  amputate  at  or  above  the 
elbow,  the  left  arm  will  be  practically  useless. 
The  best  method  of  skin-grafting  is  that  of 
Thiersch,  which  I  have  shown  you  here  a 
number  of  times.  One  point  in  connection 
with  this  operation  is  the  absolute  necessity  of 
complete  asepsis.  B^)th  the  wound  for  which 
the  grafts  are  intended,  and  the  surface  from 
which  they  are  taken,  sliould  be  carefully 
prepared  ;  in  cleansing  these  surfaces,  we  em- 
ploy warm  normal  salt  solution,  not  strong 
antiseptics,  which  are  apt  to  produce  necrosis 
of  the  tissues  and  prevent  healing.  When  we 
have  a  granulating  surface  to  deal  with,  the 
question  comes  up,  shall  we  put  the  grafts 
directly  on  the  granulations,  or  first  produce  a 
raw  surface  with  the  knife  or  curette  ?  I'he 
latter  plan,  I  think,  gives  the  best  results,  and 
in  granulating  ulcers  of  long  standing  it  is 
advisable  to  first  excise  the  ulcer,  making  an 
entirely  fresh  surface. 

Before  scraping  this  wound  with  the  curette, 
I  shall  apply  the  Esmarch  bandage.  The  state- 
ment has  been  made  that  in  making  skin-grafts 
on  the  extremities,  the  use  of  the  Esmarch  is 
contra-indicated,  the  writer  claiming  that  it 
cuts  oft"  the  blood  supply  from  the  surface, 
and  thus  interferes  with  the  growth  of  the  grafts. 
I  do  not  agree  with  this  statement.  We  have 
tried  both  methods  here,  and  I  do  not  think 
that  the    use  of  the  bandage  interferes  at  all 


i88 


THE   CANADA   MEDICAL   RECORD. 


with  the  grafts.  On  the  contrary,  if  they 
are  appb'ed  to  a  fresh  surface  from  which 
the  blood  supply  is  not  cut  off,  the  accumu- 
lation of  blood  underneath  the  grafts  may 
lift  them,  and  cause  them  to  necrose.  The 
grafts  in  this  case  I  shall  take  from  the  patient's 
thigh.  Two  parallel  incisions,  about  five  or 
six  inches  long, are  made  through  the  skin,  the 
tissues  are  then  put  on  the  stretch,  and  the 
grafts  cut  off  with  a  razor  and  immediately 
transferred  to  the  arm.  This  is  repeated  until 
the  entire  wound  is  covered.  This  newly 
grafted  surface  should  be  kept  moist,  and  for 
this  purpose  we  cover  it  with  thin  rubber 
tissues,  which  in  turn  is  covered  with  com- 
presses moistened  in  salt  solution.  This 
dressing  is  removed  in  48  hours,  and  a  similar 
one  applied.  This  is  repeated  every  two  or 
three  days  for  about  two  weeks,  when  a  dry 
dressing  with  gauze  will  usually  suffice.  Ihe 
Esmarch  is  left  on  for  about  half  an  hour.  The 
process  of  dressing  tlie  wound  on  the  thigh, 
from  which  the  grafts  were  taken,  is  very 
simple.  It  is  covered  witii  a  layer  of  rubber 
tissue  and  dry  gauze,  and  the  bandage  is  left 
undisturbed  for  seven  or  eight  days,  by  which 
time  the  entire  surface  is  usually  covered  with 
epithelium. —  2 he  Litem.  Jour,  of  Surg. 

CATHETERIZATION  OF  THE  STOMACH 
AND  CESOPHAGUS. 

In  his  recent  work  on  gastric  diseases,  Dr. 
Bouvret,  of  Lyons,  gives  a  careful  study  of 
catheterization  of  the  stomach,  and  we  are 
indebted  to  Z'  Union  Medicalc  ihi  Canada  for 
the  following  interesting  particulars  : 

The  author  advises  the  use  of  the  soft 
instruments,  made  like  the  familiar  Nelaion 
catheter,  but  quite  long,  and,  of  course,  of  a 
much  larger  calibre.  The  olivary  bougies  with 
a  flexible  stem  aie  also  of  use,  but  the  soft 
instruments  are  preferable  in  most  cases,  as 
they  allow  of  the  injection  of  alimentary  liquids, 
when  a  stricture  has  been  overcome.  A  cal- 
ibre of  12  millimeters  is  the  most  generally 
useful,  although  it  is  well  to  have  several  sizes 
on.  hand.  It  is  an  error  to  think  that  the 
smallest  sizes  arc  most  easily  introduced.  These 
instruments  must  be  kept  aseptic.  Before 
being  used,  they  are  dipped  in  a  solution  of 
boric  acid,  and  are  then  placed  in  warm 
water  for  a  few  minutes.  In  cases  of  syphilis, 
tuberculosis  and  cancer,  a  special  instrument 
should  be  kept  for  the  exclusive  use  of  the 
patient.  The  indications  for  catheterization 
are  :  Symi)toms  indicating  a  possible  stricture 
or  the  existence  of  oesophageal  diverticula  ;  dys- 
peptic phenomena  refjuiiing  investigation  of  the 
chemical  condition  of  ingcsta,  and  symptoms 
showing  the  necessity  of  washing  out  the  stom- 
ach, either  in  poisoning  or  for  the  usual  thera- 
peutical purpose.     The  author  gives  a  long  list 


of  contra-indications  to  gastric  catheterization  ; 
these  consist  in  senility,  pronounced  cachexias, 
pregnancy,  various  cardiac  and  arterial  dis- 
eases, pulmonary  conditions  associated  with 
dyspnoea  and  an  enfeebled  heart's  actions. 
Disturbances  of  the  cerebral  circulation  and 
recent  hemorrhages,  especially  from  the  brain, 
the  stomach  and  the  respiratory  system,  are  of 
great  importance  in  this  respect.  While  pa- 
tients seldom  refuse  to  lend  themselves  to  this 
procedure,  there  area  certain  number  who  will 
not  consent.  The  longer  the  duration  of  the 
disease,  and  the  more  unsuccessful  previous 
treatment  has  proved,  the  more  readily  will 
patients  consent.  It  is  rather  important  to 
succeed  at  the  first  attempt,  as  a  failure  to  pass 
the  tube  discourages  the  patient,  and  causes 
him  to  refuse  any  further  trial.  The  heart 
should  be  auscultated  before  practising  this 
proceeding,  as  well  as  the  lungs  and  aorta. 
An  aneurism  of  the  latter  may  be  the  ca^se 
of  a  stricture.  All  artificial  teelh  should  be 
removed,  unless  firmly  attached.  The  autb.or 
describes  the  procedure  to  his  patients  before 
introducing  the  tube  for  the  first  time.  He 
tells  them  that  notwithstanding  a  temporary 
sense  of  contriction  in  the  throat,  they  will  be 
able  to  breathe  quite  well,  since  the  tube  does 
not  go  into  the  wind-pipe.  When  beginning 
the  operation,  the  patient  is  told  to  breathe 
quietly  and  rather  deeply,  and -to  look  at  the 
operator,  \rho  himself  begins  to  breathe  in  this 
manner.  The  suggestive  effect  of  this  causes 
the  patient  to  do  the  same,  and  is  of  material 
benefit.  The  patient's  head  must  not  be 
thrown  back,  for  this  position  does  not  facil- 
i'atethe  introduction  and  disturbs  the  cerebral 
circulation.  The  author  has  never  found  it 
necessary  to  anaesthetize  the  pharynx,  which 
may  be  done  by  spraying  or  swabbing  with 
cocaine  solution. 

Witli  a  soft  instrument  it  is  unnecessary  to 
introduce  the  finger  into  the  patient's  mouth. 
The  tube  is  placed  upon  the  tongue  and  gently 
pushed  backward.  The  upper  orifice  of  the 
oesophagus  is  the  dfficult  place  to  pass.  The 
patient  must  be  told  to  swallow.  If  he  fails  to 
perform  this  act,  the  physician  wails,  exerting 
meanwhile  a  gentle  pressure,  and  scon  an 
involuntary  movement  of  deglutition  takes 
place.  The  tube  then  penetrates,  and  is  gently 
and  steadily  pushed  home.  The  possible  ac- 
cidents due  to  this  procedure  have  been  much 
exaggerated.  They  arise  from  inattention  to 
the  contra-indications  that  iiave  been  men- 
tioned, from  the  rupture  of  a  diseased  cosopha 
gus,  or  fiom  passage  of  the  tube  into  the  larynx, 
— a  rather  inexcusable  accident.  In  some  cases 
the  instrument  produces  sharp,  gastric  pain. 
Th\s  is  always  due  to  the  existence  of  a  local 
gastric  lesion,  ulcer,  cancer,  or  the  pressure  on 
an  adjoining  diseased  organ. — International 
Jour,  oj  Surg. 


THE  CANADA  MEDICAL  RECORD. 


189 


THE  CANADA  MEDICAL  RECORD 

Published  Monthly. 


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EDITORS : 
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London. 
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ASSISTANT  EDITOR 
ROLLO  CAMPBELL,  CM.,  M.D. 

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Editor. 


MONTEEAL,  MAY,  1895. 


SIR  WILLIAM  H.  KINGSTON. 

During  the  past  year  the  Canada  Medical 
Record  has  on  several  occasions  in  its  edi- 
torial columns  drawn  the  attention  of  the 
Government  to  the  fact  that  the  Medical 
Profession  of  Canada  was  not  receiving  its  fair 
share  of  imperial  honors  ;  that  while  there  were 
a  dozen  of  political  knighthoods  and  half  a 
dozen  legal  ones,  this  honor  had  so  far  been 
conferred  upon  only  one  medical  man.  We 
are  glad  to  be  able  to  announce  that  the 
Government  of  Canada,  recognizing  the  justice 
of  our  claim,  pres  ed  it  firmly  upon  the  British 
Government,  with  the  result  that  one  of  the 
most  distinguished  members  of  the  Profession 
in  Can;  da  was  selected  and  recommended  to 
Her  M.ijesty  ;  on  the  24th  of  May,  the  Queen's 
birthday,  ihe  honor  of  knighthood  was  con- 
ferred upon  Ur.  Wm.  H.  Kingston.  We  are  in 
a  position  to  state  that  this  action  of  the  British 
ai.d  Canadian  Governments  has  given  the 
greatest  possible  satisfaction,  not  only  to  the 
prufcssion  of  Montreal,  but  of  the  whole  of  Can- 
ada, and  indeed  wherever  Sir  W^illiam  H.  Kings- 
ton's noble  and  gentle  qualities  are  known. 
Ke  had  already  received  the  highest  honor 
which  his  brethren  could  confer  upon  him  when 
they  elected  him  many  years  ago  President  of 
the  Canadian  Medical  Association.  A  similar 
honor  had  also  been  conferred  upon  him  by 
the  Medico  Chirurgical  Society  and  the  Union 
Medicale  of  Montreal,  while  the  citizens  of 
Montreal    testified    their   esteem   by    electing 


him  their  Chief  Magistrate  or  Mayor.  But 
this  last  honor  which  has  fallen  to  his  lot,  com- 
ing as  it  does  from  the  hands  of  our  beloved 
Sovereign,  not  only  honors  the  individual  but 
honors  the  whole  noble  profession  to  which  he 
belongs.  There  is  an  old  French  saying. 
Noblesse  oblige  ;  let  this  honor  which  has  come 
to  our  profession  be  an  incentive  to  the  rank  and 
file  of  us  to  elevate  and  uphold  its  nobility  by 
burying  the  few  petty  jealousies  and  differences 
which  may  exist  among  us.  It  has  often  been 
claimed,  and,  we  believe,  justly,  that  nowhere 
on  the  continent  of  America  is  there  a  more 
honorable  feeling  governing  the  relations  of 
medical  men  to  their  brethren  and  the  public 
than  in  Montreal,  where  the  loyal  observance 
of  the  golden  rule  of  doing  to  others  as  we 
would  have  others  do  to  us  has  almost  done 
away  with  the  necessity  of  a  code  of  ethics.  For 
this  happy  state  of  affairs  we  are  largely  in. 
debted  to  the  precept  and  example  of  our  elder 
brethren,  and  to  none  more  so  than  to  Sir 
Wm.  K.  Kingston.  That  he  may  long  be  spared 
to  enjoy  the  honor  which  he  so  well  deserves  is 
the  Canada  Medical  Record's  most  earnest 
wish. 

THE   AMERICAN   MEDICAL  ASSOCIA- 
TION. 

The  recent  meeting  of  the  above  Association 
was  one  of  the  most  successful  in  its  history. 
The  papers  and  discussions  in  the  sections 
were  of  a  high  order  of  merit,  and  many  mooted 
points  in  practice  were  fairly  well  decided  upon 
as  a  result.  Work  began  punctually  each 
morning  and  afternoon  at  the  appointed  hour, 
and  the  proceedings  were  never  allowed  to 
drag  for  one  moment  until  the  hour  for  ad- 
journment came.  So  keen  was  their  thirst  for 
knowledge,  that  several  hundred  members  each 
day  devoted  the  lunch  hour  to  attending  opera_ 
tions  at  the  Johns  Hopkins  and  o'dier  hospitals 
where,  especially  at  the  former,  every  facility 
that  art  could  suggest  and  wealth  could  procure 
have  been  placed  at  the  disposal  of  the  opera- 
tors. The  general  sessions  were  presided  over 
in  a  courteous  and,  we  might  almost  say, 
elegant  manner  by  Dr.  Donald  McLean  of. 
Detroit,  whose  Presidential  address  was  a  gem 
of  Medical  literaj.ure  which  we  have  since  read 
over  several  times  without  its  losing  any  of  its 
interest.     Although   we  attended   the  meeting 


190 


THE  CANADA  MEDICAL   RECORD. 


as  an  American,  we  could  not  suppress  a  little   ; 
feeling   of  Canadian    pride   when  we    rcmem-  j 
bered  that  Dr.  McLean  was  for  many  years  a    I 
professor   in  a    Canadian    college.      It   was  a  | 
matter  of  gratification  for  all  connected  with  the   i 
Association    to   see    so  many  members  present  j 
from   the    most  distant  cities  of  the  Continent,   I 
Portland,    Ore.,    Portland,  Me..    Los  Angeles, 
Atlanta  and  San  Francisco,  one  member  from 
which     last    ciiy,    Dr.    Beverly    Cole,    luiving 
attended    nearly    thirty    meetings,   and    after 
having  travelled    on    many    occasions    twelve 
thousand  miles  by  sea  to  do  so,  was  fittingly 
rewarded  for    his    devotion    by  being   elected 
president   for  the   coming  year.     Dr.  Beverly 
Cole  is  a  courtly  old  gentleman  of  fine  address, 
and  will  doubtless  fill  the  exalted  position  with 
credit  when  the  Association  meets  at  Atlanta 
next  year.     There  was  a   notice   of  motion  to 
throw   the  membership  open  to   Canadians  on 
the  programme  ;  but  owing  to  the  absence  of  the 
mover,  Dr.  Reed  of  Cincinnati,  it  was  left  over 
till  next  year.     In  the  meantime,  the  few  Cana- 
dians who  were  present  were  received  with  that 
generous  hospitality  for  which  our  brethren  in 
the  United  States   have  obtained  a  world-wide 
reputation.     The   social  features   of  the  meet- 
ing were  not  the  least  successful    ones.     The 
leading  officials  were  the  recipients   of  much 
private  hospitality,  while  the  members  generally 
and  their  wives  were  lavishly  entertained  by  the 
profession  of  Baltimore  at  their  homes,  and  also 
at  a  banquet  and  concert  in   the  largest  music 
hall  of  the  city.      Dr.    Rohe's  banquet  to  the 
Gynecological  section  at  the  Maryland  Insane 
Asylum  was  one  of  the  most  enjoyable  ones 
we  have  ever  attended,  and  will  long  be  remem 
bered.     What  with  listening  to  papers,  attend- 
ing  operations,    renewing    charming   acquain- 
tances with  the  members  and  their  wives,  and 
attending  entertainments,  the  general  opinion 
which  we  heard   expressed  on  every  hand  was 
that  it  would  be   difiFicult   or  impossible  to  sur- 
pass the  1895  meeting  in  the  city  of  Baltimore. 

THE  K1N(;S'I0N  MEETING  OF  THE 
CANADA  MEDICAL  A.SSOCIATION. 
The  life  of  every  physician  is  a  particularly 
anxious  one,  and  one  which  is  unusually  wear- 
ing. Not  only  working  often  as  many  as  six- 
teen hours  a  day,  but  from  the  very  nature  of 
his  work,  dealing  a?  he  does  from  day  to  day 
with  questions  of  life  and   death,   the   doctor 


more  tlian  any   other  working  man  especially 
needs  a  holiday.     When   and  where  to  take  it 
is  a  good  deal   a  matter  of  taste.     It  is  said 
tliat  a  New  York  street  car  driver,  when  given 
a    week's    holidays,  sj5ent   it  in  riding  up  a;id 
down  on   the    street   cars  with   another  driver 
who  was   on   duty  ;  some   physicians  feel  that 
they  are  benefited  in  body  and  mind  by  visiting 
their  brethren  in  other  cities  and  watcliing  them 
at  Work.     Others   derive  most   recreation  by  a 
week  or  two  communing  with  nature  by  forest, 
lake  or  stream.    This  being  a  complete  change 
probably  does  the  most  good.     But  the  wisest 
way    of  all    is   a    combination    of   these   two 
methods,  an   opportunity  for  which  is  aftbrded 
by  the  meeting  of  the  Canada  Medical  Associ- 
ation in  Convocation  Hall,  Queen's  University, 
Kingston,  on  the  28th,  29th  and  30th  of  August, 
which  promises  to  be  one  of  the  most  success- 
ful  meetings  in  the  history  of  the  Association. 
The  place  of  meeting  is   about  the  centre  of 
Canada,  and  the  time  ths  most  convenient  pos- 
sible.    The  meeting  will   be  presided  over  by 
Dr.   William  Bayard,  a  hale  and  hearty  doctor 
over  eighty  years  of  age.       It  is  expected  also 
that  Sir  Charles  Tupper,  M.D.,  the  first  presi- 
dent of  the  Association,  will  also  be  present. 
The    programme    will  also   be  of  exceptional 
interest,    so    that   what   one    learns   at  such  a 
meeting  repays  him  many  times  for  the  time 
and  expense.     Kingston  is  the  centre  of  tourist 
trips,  so  that  before  or  after  the  meeting  one 
can  retire    to   some   secluded  spot,    or  take  a 
series   of  trips  on  the  rivers  and   lakes  in  the 
vicinity,  until  a  good  stock  of  health  has  been 
laid  in  to  meet  the  demands  of  the  Iiard  winter's 
work.     For  those  who  take  an  interest  in  elec- 
tricity, which  is  now  assuming  so  much  impor- 
tance in   the  treatment  of  nervous   and  female 
diseases,   a    hearty    invitation    is    extended  to 
attend    the   meetings  of  the  American  Electro- 
Therapeutic  Association  which  meets  in  Tor- 
onto on    the  first  three  days  of  September.     If 
for  no  otiier  reason,  finally  at  least  from  motives 
of  patriotism,  lei  each  individual  member  of  the 
Canadian    medical    j)rofession     feel    that   the 
success    of  our    national   organization  depends 
upon  our  presence  there.     Out  of  six  thousand 
physicians    in  Canada  there  should  at  least  be 
si.^  hundred  i)resent.     The  railway  and  steam- 
boat  companies   will   allow  the    usual  rates  of 
one  fare  and  a  third  for  the  return  ticket. 


THE   CANADA   MEDICAL   RECORD. 


191 


THE     BUFFALO      MEDICAL     AND 
SURGICAL  JOURNAL. 

'There  ar^  very  few  medical  journals  in  this 
new  com. try  that  have  lived  to  reach  the  age 
of  fifty  years.  Those  which  have  done  so 
have  been  founded  well  and  been  ably 
managed,  for  only  the  fittest  can  survive. 
This  is  no  exception  to  the  rule.  No  one  can 
have  read  tiie  above  journal  regularly  for  the 
last  ten  years  as  the  writer  has  done,  without 
having  felt  that  a  man  of  more  than  usual 
energy  and  ability  was  at  the  head  of  it, 
while  all  who  know  Dr,  William  Warren 
Potter  will  recognize  at  once  that  he  is  just 
such  a  man  as  could  bring  these  results  about. 
We  congratulate  ihe/ourua/on  its  jubilee,  and 
we  wish  for  the  Buffalo  Medical  (0  Surgical 
Journal  at  least  another  fifty  years  of  such 
prosperity  as  it  has  had  in  the  past,  and  we 
trust  that  its  editor  may  long  be  spared  to 
direct  its  usefulness.  Its  reading  pages  will, 
we  are  informed,  be  largely  increased,  and 
other  improvements  will  be  made  which  will 
greatly  increase  its  value  to  its  readers. 


BOOK  NOTICES. 

Index   of  Medicine.      By   Seymour   Taylor, 
M.D.,    Member  Royal  College  of  Physi- 
cians,  Senior  Assistant   Physician   to  the 
West   London    Hospital.       In    one    large 
i2mo.    volume  of  801  pages,  with  35  en- 
gravings.     Cloth,    $3.75.       Philadelphia: 
Lea  Brothers  &  Co. 
The   author   has   prepared   a  work  of  great 
value  alike   to  physicians  and  students.     In  a 
certain  sense  the  name  "  Index  "  is  a  misnomer, 
for  the  volume  is  in  fact  a  concise  "  Practice  of 
Medicine,"   the   diseases    being   grouped   sys- 
tematically in   order  to  secure  for  the  reader 
the  many   advantages    resulting  from  rational 
arrangement.         After    valuable    chapters    on 
'•  Disease,"    "  General    Pathology,"    '•  General 
Diseases,"  "  Specific  Infectious  Diseases,"  and 
"  Specific  Fevers"  the  various  organs  and  sys- 
tems of  the  body  are  considered,  and  the  cause, 
symptoms,  pathology,  treatment  and  prognosis 
ofeach  affection  are  succinctly  stated.     Numer- 
ous illustrations,   together  with    tabulations  of 
differential  diagnosis,  tests,  etc.,  elucidate  the 
text  and  condense  a  great  amount  of  necessary 
knowledge  in  the  clearest  manner.     The  work 
is  one  which  merits  and  will  doubtless  obtain  a 
wide  popularity. 


The  author   enjoyed  during  many  years  the 
privilege  of  listening  to  the  lectures  of  Peacock, 
Bristowe,  Ordand  Shand-Smith,and  he  states  in 
his    pieface    that  his  work  is   largely  prepared 
from  his  own  notes  taken  at  their  didactic  and 
clinical  lectures.     This  has  given  to  it  a  decid- 
edly practical  aspect,  and  we  cannot  read  even 
the  first  chapter  without  being  charmed  with  the 
clearness  and  conciseness  of  the  author's  style. 
A  Book  of  Detachable  Diet  Lisrs.     For  al- 
buminuria, aniemia  and  debility,  constipa- 
tion, diabetes,  diarrhoea,  dyspepsia,  fevers, 
gout  or  uric  acid  diathesis,  obesity,  tuber- 
culosis, and  a  sick-room  dietary.  Compiled 
by  Jerome  B.Thomas,  A.B.,  M,D.,  Visiting 
Physician    to    the  Home    for    Friendless 
Women   and   Children  and  to  the    News- 
bo\s'Home;  Assistant  Visiting  Physician 
to  the  Kings  County   Hospital  ;  Assistant 
Bacteriologist    Brooklyn    Health   Depart- 
ment.    Published  by  W.  B.  Saunders,  925 
Walnut    Street,     Philadelphia,    Pa.    1895. 
Price  $1.50. 
With   this    book   on    his    desk,  all   that   the 
physician  has  to  do  is  to  tear  out  a  list,  check 
off  the  food  prescribed,  and  hand  the  list  to  the 
patient.    Many  a  time  the  physician  feels  that  it 
would  be  much  better  for  the  patient  if  he  had 
his   dietary  written  out ;  but  being  pressed  for 
time,  he  is  often  reluctantly  compelled  to  leave 
his  orders  in  a  verbal  manner.     This    book  of 
detachable  leaves  meets  this  difticulty.     No  one 
could  think  of  all   the   suitable  and  unsuitable 
articles  of  diet  for  a  given  case  on  the  spur  of 
the  moment ;   but   everything  will  be  found  in 
these  complete  lists.     The  lists  are  numbered, 
and  the  key  to  the  numbers  is  reserved  for  the 
physician.     They   will   be   found   exceedingly 
handy. 

'I  HE  Treatment  of    Wounds,  Ulcers   and 
Abscesses.    By  W.  Watson  Cheyne,  M.B., 
F.R.S.,   F.R.C.S.,  Professor  of  Surgery  in 
King's    College,    London.     Inonei2mo. 
volume  of   207    pages.         Cloth,     $1.25. 
Philadelphia  :  Lea  Brothers  &  Co  ,  1895. 
This  little  work  owes  its  brevity  and  its  wide- 
spread usefulness  to  the  fact  that  it  is  devoted 
wholly    to    the   treatment   of  affections  which, 
though  nominally  surgical,  are  yet  so  common 
as    to  form  part  of  the   daily  work  of  every 
practitioner.     Antiseptic  methods  have  revolu- 
tionized   surgical  procedures    and  have  added 
vastly  to  their  successes.     Moreover,  by  throw- 
ing  light    upon    formerly  unexplained  failures, 
they  have   increased    not   only  the  knowledge 
but  also   the  confidence  of  the  surgeon,  an  ele- 
ment  which   must    be  recognized  as  having  an 
iiTiportant   influence    upon    results.     Professo 
Cheyne  has   long   been    known    as  one  of  the 
foremo.st  of  London  surgeons,  and  as  a  critical 
student  of  antiseptic  procedures  in  their  prac- 
tical  bearings.     In    this    volume    he    has    de- 
scribed   the   methods   of  treatment    which  he 


192 


THE   CANADA    MEDICAL   RECORD. 


employs,  and  which  he  knows  "  to  be  tflficient 
and  to  l)e  tiie  simplest  consistent  with  certainty 
in  re?uUs." 

'1'he  Year  Book,  of  Treatmknt  kor  1895. 
A  comprehensive  and  criical  review  for 
practitioneis  of  Medicine  and  Surgery.  • 
In  one  i2mo  volume  of  501  pages.  Cloth, 
$1.50.  Philadelnh  a  :  Lea  Brothers  & 
Co.,  T895. 
The  eleventh  consecutive  issue  of  this 
annual  summary  of  medical  progress  will  in- 
terest the  wide  circle  of  readers  who  have 
learned  its  substantial  value.  To  have  the 
real  advances  in  treatment  in  all  departments 
of  medical  practice  culled  by  recognized 
specialists  from  the  immense  mass  of  medical 
literature,  and  presented  with  critical  remarks 
in  a  classified  form  for  immediate  use,  is 
assuredly  a  help  towards  success  which  busy 
practitioners  will  not  neglect,  and  which  other 
practitioners  will  consult  for  the  soundest  of 
business  reasons.  The  reader  interested  in  a 
special  subject  can  quickly  post  himself  on 
whatever  is  new  and  good  in  treatment  by  a 
perusal  of  the  chapter  devoted  to  it,  and  the 
general  practitioner  can  with  facility  turn  to 
any  topic  by  a  glance  at  the  index.  Those 
desiring  to  read  up  the  literature  of  any  subject 
can  find  no  more  convenient  guide  than  the 
selected  list  of  new  books,  new  editions  and 
translations.  The  volume  is  exceedingly  cheap 
in  proportion  to  intrinsic  value  and  service- 
ableneso. 


CLASS-ROOM  NOTES. 

Prof.  Keen  says  warty  tumors  are  best  re- 
moved by  the  application  of  a  caustic,  such  as 
sulphuric  acid  or  nitric  acid  :  and  if  removed 
by  mechanical  means  their  bases  should  invari- 
ably be  touched  by  a  strong  caustic. 

In  cases  of  rheumatic  fever,  Prof.  Wilson 
says  the  heart  may  become  affected  in  all  kinds 
of  cases.  The  mildest  cases  suffer  as  well  as 
the  severest.  The  heart  may  alrio  become 
affected  at  any  stage  of  the  disease,  but  very 
seldom  during  the  earlier  itages  of  an  attack. 


do  its  work.  Tliere  are  a  number  of  ailmenis,  not  close- 
ly defined,  which  are  due  to  the  presence  of  the  malarial 
poison.  All  such  conditions  are  greatly  benefited  by 
the  use  of  antikamnia  and  quinine.  In  headache  (hemi- 
crania),  in  tht  neuralgias  occurring  in  ansemic  patients 
who  have  malarial  cachexia,  and  in  a  large  number  of 
affections  more  or  less  dependent  upon  this  cachectic 
condition,  the  regular  administration  of  this  combination 
will  prodac  the  most  happy  results.  In  cases  of 
malarial  fever  it  should  be  given  as  a  prophylactic  and 
cur.'. 

"Aniikamnia  and  Quinine"  are  put  up  in  tablet  form, 
each  tablet  containing  two  and  one-half  grains  of  anti- 
kamnia and  twj  and  one  half  grains  of  quinine,  and  is 
the  most  satisfactory  mode  of  exhibition. 


PUBLISHERS  DEPARTMENT. 

MALARIAL  CONDITIONS. 

For  all  malaiial  conditions  quinine  is  the  best  remedy 
we  have.  But  associated  with  this  condition  there  is 
always  more  or  less  pain,  whicii  often  renders  the  life  of 
the  individual  uncomfortable,  if  not  positively  miserable. 
Aniikamnia  will  remove  these  unpleasant  symptoms,  and 
place  the  .system  in  the  best  condition  for  the  quinine  to 


A  NEW  ART  EDITOR. 

VViLLi.A.M  Martin  Johnson,  who  illustrated  the  "Gar- 
field ■'  edition  of"  Ben  Ilur  "  for  the  Harpers,  andalso- 
their  editions  of "  The  Cloister  and  the  Hearth"  and 
"  Hypatia,"  becomes  the  art  editor  of  the  The  Ladies'' 
Hotne  Jourmil  on  June  1st,  leaving  New  York  to  reside 
permanently  in  Philadelphia.  Mr.  Barton  Cheyney,  a 
clever  newspaper  man,  who  has  been  attached  to  the 
press  of  Delaware  and.  Pennsylvania,  is  also  added  to 
the  Journal's  editorial  staff  as  one  of  Mr.  Bok's  princi- 
pal associates. 


JULIA  MAGRUDER'S  NEW  NOVEL. 

Miss  Julia  M.\gruder,  whose  story  of"'  The  Princess 
Sonia,'  in  the  Century,  is  attracting  such  favorable  com- 
ment, has  given  her  new  novel  to  The  Ladies  '  Home 
Journal.  It  is  called  "  The  Violet,"  and  deals  with  the 
question  of  second  marriage.  Mr.  C.  D.  Gibson,  the 
illustrator,  is  making  a  series  of  pictures  for  the  novel. 


While  at  this  time  other  magazines  are  pressing  their 
claims  to  the  favor  of  the  intelligent  public,  those  of 
Littelfs  Lii'ing  Age  are  not  likely  to  be  forgotten  by 
those  who  know  what  its  services  have  been  in  the 
spread  of  the  best  periodical  literature  throughout  this 
continent. 

The  price  of  the  magazine,  $8.00  a  year,  is  small  in 
view  of  the  vast  quanuty  and  high  quality  of  its 
contents,  a  year's  numbers  forming  four  large  octavo 
volumes  of  824  pages  each.  Asa  special  inducement, 
to  any  who  desire  to  make  a  trial  subscription,  the 
twenty-six  numbers,  forming  the  first  half  of  the  year 
1895  (January  to  J'une  inclusive),  will  be  sent  for 
$300.  To  .anyone  remitting  $0.00  in  payment  for 
the  nine  months,  .Vpril  to  December  inclusive,  the 
thirteen  numbers  forming  the  first  quarterly  volume  of 
1894  will  l)e  sent  free. 

Perhaps  no  better  exhibit  could  be  found  of  the  pro- 
gress and  expansion  of  thought  in  the  different  fields  of 
literature,  politics  and  science  during  the  last  half 
century  than  a  complete  set  of  Lit/ell's  Living  Age 
would  present.  Each  volume  is  a  mirror  rellecting  the 
living  literature  of  the  month  it  covers. 
Published  by  Littell  iV  Co.,  Boston. 


WM 


Vol.  XXIII. 


MONTREAL,  JUNE,  1895. 


No.  9. 


ORIGINAL  COMMUNICATIONS. 

Home  and  Foreign  Climate  in  Cim- 
fsuinption 193 

The  Etiology  and  Treatment  of 
Inflammations  of  the  Uterine  Ap- 
pendages    IOC) 

A  Plea  for  Efficient  Legislation  Re- 
gulating Medical  Practice. -  197 

SOCIETY  PROCEEDINGS. 

Montreal  Medico-Cliirurgical  Soci- 
ety    199 

Death  from  Chloroform 200 

Dislocation  of  the  Ninth  Dorsal  Ver- 
tebra treated  by  Extension 203 


GOnSTTEIsTTS. 

Arthrectomy '.iOS 

Scurvy   in  Children,  with  notes  on 
two  Cases 203 


PROGRESS  OF  SCIENCE- 

Apocynuni   Cannabinum  as   a    Car- 

dio-Kinetic  and  Diuretic,  207 

New    Metdod    of   Sterilizing    Liga- 
tures    207 

Operative  Treatment  of  Wry  Neck. .  208 
Improved  Method  of  Radical  Oper- 
ation for  Cancer  of  the  Breast. .  208 

Defects  in  Surgical  Practice 208 

Class-Room  Notes 20S 


EDITORIAL. 

The  Canadian  Medical  Association. .  209 

What  Doctors  Die  from  209 

Correspondence 210 

The  Medical  Council  213 

BOOK  NOTICES. 

Medical  Gyn;«cology 214 

A    Manual  of  the  Modern  Theory 

and  Technique  of  Surgical  Asepis.  215 
A  Ginde  to  the  Aseptic  Treatment  of 

Wounds 215 

Publishers  Department 216 


|rt0fnal    ^Communications. 


HOME  AND     FOREIGN    CLIMATE 
IN  CONSUMPTION.* 

Prepared  for  reading  at  1 5//^  Annual  Meet- 
ing of  Otiiario  Medical  Association, 
June,  1895.  By  EDWARD  Playter, 
M.D.,  Ottawa. 

There  are  three  principal  points  to 
which  I  propose  to  draw  attention  in  this 
brief  paper, — namely:  the  empirical  and 
uncertain  nature  of  a  change  to  a  different 
climate  as  a  remedy  for  consumption  ; 
(2)  acclimatization  ;  and  (3)  the  easy 
dispensability  of  the  remedy. 

(i)  That  change  of  climate  in  the 
treatment  of  consumptives,  in  the  present 
state  of  our  want  of  knowledge  of  the 
influences  and    efl"ects    upon    the    human 

*  (Mostly  Extracts  from  Original  Manuscript  of  a 
Work  on  Consumption,  now  in  Printers'  hands  for 
Publication.) 


functions  of  the  many  and  various  atmo- 
spheric conditions  which  go  to  make  up 
climate,  is  a  very  uncertain  and  empirical 
remedy,  I  shall  not  here  enter  into  a 
discussion  to  prove,  but  simply  quote  the 
following  few  words  from  two  recent 
authorities.  H.  S.  Davis,  jun.,  A.M.^ 
M.D.,  of  Chicago,  in  a  recent  work  on 
Consumption,  remarks  :  "  Often  a  choice 
of  climate  is  no  easy  matter.  The  selec- 
tion is  frequently  made  easier  by  watch- 
ing the  effect,  in  a  given  patient,  of 
different  kinds  of  weather."  Frank  S. 
Parsons,  M.D.,  editor  of  the  Times  and 
Register,  in  a  recent  paper,  "  A  Practical 
Theory  and  Treatment  of  Consumption," 
says  :  "  The  only  way  to  test  a  given 
location  for  a  phthisical  person  to  reside 
in  is  for  such  person  to  test  the  various 
locations ;  " — that  is,  personally,  by  a 
brief  sojourn  in  each. 

(2)  Acclimatization  is  a  physiological 
process,  the  possible  injurious  effects  of 
which   upon    the   already  deranged   con- 


194 


THE   CANADA   MEDICAL   RECORD. 


stitution  of  the  consumptive,  it  appears 
to  me,  arc  too  commonly  overlooked.  It 
is  very  well  known  that  healthy,  vigorous 
persons  are  sometimes  injuriously  affected 
by  a  change  of  climate.  Hence  we  can 
never  be  certain  that  benefit  received  will 
fully  compensate  for  any  detrimental 
effects  the  altered  conditions  may  pro- 
duce upon  the  organism.  Parkes 
writes  :  "  How  soon  the  body  when  it 
has  become  accustomed  by  length  of 
residence  for  successive  generations  to  one 
climate,  can  accommodate  itself  to,  or  bear 
the  conditions  of,  the  climate  of  another 
widely  different  place,  is  a  question  which 
can  only  be  answered  when  the  influences 
of  climate  are  better  known.  The  hypo- 
thesis of 'acclimatization  '  implies  that  there 
is  at  first  an  injurious  effect  produced,  and 
then  an  accommodation  of  the  body  to  the 
new  conditions.  Probably  we  do  not 
know  sufficiently  the  physiological  con- 
ditions of  the  body,  under  different  cir- 
cumstances." The  effects  on  the  human 
body  of  a  change  to  a  great  elevation, 
when  not  made  gradually,  are  remarkable 
and  sometimes  alarming. 

(3)  Is  a  change  to  a  warm  or  an  elevated 
climate  in  the  treatment  of  consumption 
necessary  ?  In  my  opinion,  based  on  a  some- 
what limited  experience,  yet  a  good  deal  of 
observation  and  study,  it  is  very  rarely 
necessary,  although  a  change  of  locality, 
as  from  a  heavy,  damp  soil  to  a  dryer 
perhaps  more  elevated  one,  or  from  an 
urban  to  a  rural,  is  frequently  desirable 
and  essential.  In  certain  advanced,  in- 
curable cases,  doubtless  life  may  be 
rendered  more  comfortable  and  perhaps 
prolonged,  by  residence  in  a  warm, 
equable,  and,  in  laryngeal  cases,  humid 
climate.  And  again,  in  a  very  few  cases, 
such,  for  example,  as  that  of  a  young  man 
in  a  pretubercular  condition,  or  in  the 
early  stage  of  the  disease,  who,  indifferent 
about  his  health,  will  not  attend  properly 
to  the   practice    of    lung  gymnastics,    and 


who  has    the  means,  and  no  objection,  to 

go  from  home,  a  chan<::^e  to  an  elevated 
region,  where  the  rarefied  atmosphere  with 
its  small  bulk  percentage  of  oxygen  will 
compel  him  to  exercise  a  kind  of  lung 
gymnastics,  may  be  advisable. 

Time  and  science,  theory  and  practice, 
have  at  length  taught  us  that  what  the 
consumptive  needs,  first  of  all, — indeed,  last 
of  all,  and  always, —  is  more  pure  air,  or,  to 
be  more  definite,  more  oxygen,  and  this 
element  in  its  best,  most  vitalizing  con- 
dition, for  it  evidently  has  several  con- 
ditions. This  need,  this  essential,  cannot 
be  best  supplied  by  a  warm  atmosphere 
nor  by  a  rarefied  or  thin  atmosphere. 

The  consumptive,  whether  from  heredity 
or  habit,  is  an  imperfect  breather.  In  the 
development  of  the  soil  for  the  tubercle 
bacillus  an  imperfect  respiratory  function 
plays  the  chief  part.  In  the  development 
of  the  soil  for  tubercular  phthisis,  all  other 
causes  are  remote,  and  contribute  to  this 
one — an  imperfect  respiratory  function. 
The  air  cells  or  air  chambers  of  the  lungs, 
aiKl  the  blood  and  tissues  of  the  body, 
have  become  clogged  with  the  debris  or 
products  of  imperfect  tissue  metabolism 
from  want  of  oxygen  :  while  it  seems  not 
improbable  that  in  the  decomposition  of 
the  accumulated  waste,  not  only  are  inor- 
ganic substances  formed  which  constitute 
food  for  the  bacilli,  but  also  possibly 
organic  toxines,  which  transform  non. 
x'irulent  saprophytic  bacilli  into  virulent 
pathogenic  infections;  an  analogue  of 
which  we  find  in  respect  to  a  like  transform- 
ation in  the  bacillus  coli  communis,  from 
the  toxines  of  fi\;cal  matter.  In  the 
rarefied  air  of  high  mountains,  with  per- 
haps, too,  the  climbing,  there  is  great  and 
forced  expansion  of  the  lung  membrane, — 
the  subject  is  compelled  to  actually  gasp 
widely  for  breath,  expanding  the  lungs  to 
tljeir  utmost,  the  whole  function  of  breath- 
ing is  aroused,  the  air  chambers  of  the 
remotest  recesses  of  the  apexes  are  opened 


THE   CANADA   MEDICAL   RECORD. 


195 


up,  and  the  walls  of  the  chambers  every- 
where attenuated  and  purified.  Thus  an 
improved  breathing  function  is  establish- 
ed, while  there  is  in  the  expansion  full 
compensatory  action,  perhaps  for  the  time 
more  than'  full,  for  the  thin  atmosphere, 
and  so  not  infrequently  improved  general 
health  follows. 

As  already  intimated,  however,  and  as 
we  all  know,  great  elevation  is  not  neces- 
sary for  the  cure  of  consumption.  Not 
only  is  this  the  case,  but  the  indications 
can  be  better  fulfilled  at  much  lower  levels 
where  the  proportion  of  oxygen  in  the 
same  bulk  of  air  is  much  greater. 

The  benefits  which  may  be  sometimes 
derived  from  compressed  air — air  con- 
taining an  excess  of  oxygen — in  the  treat- 
ment of  consumptives  need  not  be  dwelt 
upon  here,  nor  need  the  fact  that  at  sea,  at 
which  level  the  proportion  of  oxygen  in 
the  atmosphere  is  greatest,  the  mortality 
from  this  disease  among  sailors  between 
the  ages  of  15  and  45  has  been  found  to 
be  sixteen  times  less  than  on  land, — a  fact 
not  attributable  alone  to  the  purity  of  sea 
air. 

There  is  no  doubt  whatever,  as  Davis, 
already  quoted,  in  a  later  work,  on 
Diseases  of  the  Lungs,  Hearts  and  Kid- 
neys, remarks  :  "  That  the  chest  can  be 
gradually  enlarged  by  lung  gymnastics 
quite  as  much  as  by  high  altitude  life, 
provided  only  one  will  be  sufficiently  per- 
severing." Dr.  Davis  in  no  measure 
opposes  altitude  ; — on  the  contrary,  he 
favors  it.  And,  furthermore,  not  only  can 
the  respiratory  function  be  quite  as  effect- 
ually developed  and  improved  by  suitable 
gymnastic  exercises  at  home  or  in  one's 
native  climate,  but  increased  and  improv- 
ed more  safely.  There  is  considerable 
risk  in  conveying  persons  somewhat  ad- 
vanced in  the  disease,  with  haemorrhage, 
directly  to  a  great  altitude  ;  with  proper 
and  careful  lung  expansion  at  home,  no 
risk  whatever. 


The  purer  atmosphere  of  great 
elevations  is  an  important  condition.  But 
in  large  regions  of  Canada  we  have  a 
pure  and  highly  ozonous  atmosphere  at 
all  seasons,  while  over  our  snow-covered 
expanses  during  many  months  of  the 
year  is  an  atmosphere  practically  germ- 
less,  or  about  as  near  to  it  as  is  sea  or 
mountain  air, — a  fact  which  seems  to  be 
entirely  overlooked. 

Respecting  the  cold  of  our  Canadian 
climate,  the  colder  the  air  breathed,  the 
more  oxygen  it  contains,  and  the  more 
invigorating  it  is,  while  at  the  same  time, 
on  becoming  warmed  in  the  lungs,  it  ex- 
pands, in  a  proportionately  greater  degree, 
the  air  chambers.  Consumptives  here,  who 
in  nearly  all  cases  have  acquired  a  predis- 
position to  the  disease  by  means  of  indoor 
occupations  or  a  habit  of  housing  in  over- 
heated rooms,  may  be  almost  without  ex- 
ception, and  notwithstanding  the  cold, 
gradually  habituated  back  again  to  an  out- 
door life.  By  proper  attention  to  the 
skin,  suitable  clothing,  and,  especially,  by 
means  of  the  cool  bath,  the  most  suscep- 
tible of  such  patients  may  be  gradually 
inured  to  living  outdoors,  almost  constant- 
ly at  all  seasons  ;  more  easily  if  the  inur- 
ing process  be  commenced  in  the  autumn, 
although  it  may  be  commenced  at  any 
time.  Patients  advanced  in  the  disease, 
who  had  not  been  out  doors  for  months, 
because,  as  they  said,  going  out  made 
their  cough  worse,  I  have  induced  to  go 
out  and  spend  much  time  out,  in  cold 
weather,  sometimes  with  a  little  incon- 
venience at  first,  always  with  much  per- 
manent after-benefit  ;  and  never  once  have 
I  known  anything  like  serious  harm  to 
follow,  the  chief  points  to  be  attended  to 
being,  the  daily  cool  bath,  abundance  of 
clothing,  especially  when  exercise  cannot 
be  taken,  and  breathing  through  the  nos- 
trils. 

The  sudden  changes  from  heat  to  cold 
in  our  Canadian  climate,   while   invigorat- 


196 


THE   CANADA    MEDICAL   RECORD. 


ing  to  persons  in  fair  health,  are  sometimes 
trying  to  the  already  debilitated  consump- 
tive ;  although  most  consumptives  bear 
great  changes  of  temperature  wonderfully 
well  if  not  directly  exposed  to  strong 
drafts  of  air.  Such  changes,  however,  are 
less  marked  and  sudden  here  than  they 
are  at  high  altitudes.  At  Davos  (Switz.)^ 
for  example,  less  than  6.000  feet  above  sea 
level,  the  thermometer  has  registered 
166^  F.  by  day  in  the  sun,  and  fallen 
at  night  to  16  ^  F.— a  "  drop  "  of  1 50  °   F. 

In  conclusion  it  may  be  said,  then  :  we 
have  at  our  own  doors,  in  Canada — in 
Ontario  and  Quebec, — probably  some  of 
the  best  localities  for  consumptives  on  this 
planet ;  and  it  is  my  opinion  that,  not  in  one 
case  in  a  hundred  need  there  be  a  change 
to  another  climate  by  any  consumptive, 
being  a  native  Canadian,  in  whom  there  is 
a  prospect  of  recovery. 

Of  special  localities  more  particularly 
favorable  to  this  class  of  persons  there 
are  several  in  these  provinces.  Muskoka 
has  acquired  a  reputation  for  being  a 
highly  favorable  place  for  consumptives. 
It  is  sufficiently  elevated,  has  a  pure,  invi- 
gorating atmosphere,  and  a  large  number 
of  sunny  days. 

The  ideal  place  of  all  for  promoting 
health  and  vigor,  so  far  as  I  have  been 
able  to  learn,  and  which  I  beg  leave  to 
here  very  briefly  describe,  is  a  somewhat 
limited  locality  in  the  Gatineau  Mountains. 
a  few  miles  from  Ottawa,  in  the  neigh- 
borhood of  Chelsea  station  and  Kings- 
mere  and  Kings  Mountain — Kings  Lake 
Mount,  and,  it  may  well  be  named,  Kings 
Plateau.  It  is  about  1,000  feet  above  the 
sea  level  and  500  above  the  adjoining 
country,  the  mountain  side  rising  rapidly, 
somewhat  precipitously,  although  provid- 
ing for  a  good  driving  roadway.  Hence 
it  affords  the  best  of  drainage  and  free- 
dom from  malaria,  while  any  possible 
atmospheric  impurities  gravitate  to  the 
lower  strata  of  air.      It  is    most  pleasantly 


exposed  to  sunshine  by  a  southeastern 
aspect,  while  behind  it,  protecting  it  from 
northern  and  western  blasts,  is  a  well 
wooded  ridge  towering  paternally  and 
kingly  up  300  feet  higher.  According  to 
the  meteorological  record  of  the  locality, 
the  number  of  sunny  days  is  about  one- 
sixth  greater  than  in  Toronto  and  one- 
thirJ  greater  than  in  Montreal.  The  air 
is  of  the  purest  and  most  exhilarating 
character,  and  Kingsmere  is  a  very  pretty, 
though  small,  b:)dy  of  clear  spring  water, 
and  speckled  trout.  From  this  plateau 
one  may  view  about  4,000  square  miles 
of  a  beautiful  country — from  40  to  50 
miles  in  each  of  the  three  directions — to 
the  right,  to  the  left  and  in  front,  hill  and 
dale,  cultivated  fields,  meadows  and  wood- 
land ;  the  Ottawa,  Rideau  and  Gatineau 
rivers,  their  valleys,  windings  and  water- 
falls ;  with  our  beautiful  capital  city, 
built  on  the  hills  at  the  junction  and 
mingling  of  the  three  waters,  and  our 
stately  Parliament  buildings,  as  if  silently 
watching  their  tumultuous  meeting,  a  very 
Greek  (or  Persian)  Tla/oaSetcro?  (park  or 
paradise)  of  health  and  beauty, 

THE  ETIOLOGY  AND  TREAT- 
MENT OF  INFLAMMATIONS  OF 
THE  UTERINE  APPENDAGES. 

Dr.  Augustin  H.  Goelet,  of  New  York, 
read  a  paper  on  this  subject  at  the  recent 
meeting  of  the  American  Medical  Associa- 
tion at  Baltimore,  in  which  he  stated  that 
the  contention  was  not  that  these  inflam- 
mations of  the  tubes  and  o\'aries  can 
always  be  cured,  but  that  it  is  frequently 
possible,  and  unless  immediate  operative 
interference  is  absolutely  demanded,  the 
patient  should  be  given  the  chance,  and 
the  attempt  should  be  made  before  sub- 
mitting her  to  a  radical  operation.  This 
hC'  thought  particularly  important  since 
treatment  directed  toward  attaining  this 
end  did  not  militate  against  a  subsequent 


THE   CANADA   MEDICAL   RECORD. 


197 


operation  for  their  removal  should  it  be- 
come necessary,  but,  on  the  contrary,  im- 
proved the  chances  of  an  ultimate  success- 
ful result.  He  called  attention  to  the  fact 
that  when  once  removed  these  organs  can- 
not be  replaced,  and  asked  the  question 
if  it  was  not  a  serious  error,  in  the  light  of 
recent  developments  in  the  etiology  and 
pathology  of  the  inflammations  of  the 
appendages,  to  remove  these  organs  with- 
out previous  attempt  at  a  cure  or  remov- 
al of  the  cause  which  may  be  operating 
to  maintain  such  condition.  It  may  be 
denied  that  diseased  tubes  and  ovaries  are 
removed  unnecessarily,  but  it  must  be 
admitted  that  they  are  too  often  removed 
for  disease  which  is  amenable  to  patient 
and  persistent  treatment,  or  which  may  be 
cured  by  a  minor  surgical  operation,  in- 
volving no  risk,  such  as  curettage  or 
repair  of  a  lacerated  cervix. 

If  these  cases  are  submitted  to  careful 
treatment  instituted  for  the  purpose  of 
clearing  up  the  surrounding  exudation 
and  favoring  drainage  through  the  natural 
channel  (the  uterus),  in  many  instances  the 
necessity  for  a  radical  operation  would  be 
removed,  and  the  woman  would  be  restored 
to  a  life  of  usefulness  and  happiness. 

In  corroboration  of  these  views,  he  re- 
ported 12  selected  cases  which  had  come 
to  him  from  other  gynaecologists,  who 
believed  that  removal  of  the  diseased 
organs  was  the  only  method  to  be  adopted 
for  restoration  of  their  health,  yet  these 
patients  recovered  completely  without  the 
loss  of  these  organs. 

The  writer  stated  that  these  were  not 
the  only  cases  with  such  an  unfavorable 
outlook  which  he  had  been  able  to  cure 
in  this  manner,  but  they  had  been  selected 
from  among  a  number  of  others  because 
they  had  consulted  other  gynaecologists 
before  they  came  under  his  observation. 


A  PLEA   FOR  EFFICIENT  LEGISLA- 
TION REGULATING  MEDICAL 
PRACTICE* 

Py  Perry  H.  Millard,  M.D.,  of  St.  Paul. 

During  the  last  decade  no  question  in  medi- 
cal sociology  has  attracted  greater  attention 
than  medical  education.  The  requirements  of 
our  colleges  not  being  upon  a  par  with  those 
of  othei- countries,  nor  with  other  departments 
of  education  in  this  country,  it  was  but  natural 
that  the  profession  as  a  whole,  the  medical  press 
and  organized  bodies  of  medical  men,  should 
join  in  a  demand  for  needed  reforms.  During 
the  formative  period  of  our  history  it  is  but 
natural  that  abuses  should  have  arisen  in  me- 
thods of  education  and  obtain  a  firm  rooting. 
A  spirit  of  criticism  exists  that  will  not  subside 
pending  the  definite  determination  of  a  ques- 
tion of  such  vital  interest  to  the  profession  of 
the  country. 

As  a  nation  during  the  first  century  of  our 
history,  we  have  established  a  system  of  common 
school  education  that  challenges  the  admiration 
of  the  civilized  world.  It  is  a  subject  of  regret, 
however,  that  in  certain  advanced  lines  (f  educa- 
tion our  methods  have  i)roven  most  defective. 
This  is  true  of  medical  education  ;  a  system 
having  secured  foothold  with  us,  that  is  indeed 
anomalous. 

Having  no  support  other  than  the  fees  of 
students  ;  without  university  or  college  connec- 
tion ;  without  support  from  the  State,  generally 
accorded  other  systems  of  education  ;  without 
restraining  legislative  enactments;  without  laws 
regulating  the  granting  of  charters  for  purposes 
of  medical  instruction  ;  it  is  indeed  little  wonder 
that  at  the  end  of  the  first  century  of  our  his- 
tory as  a  nation,  chaos  should  reign  supreme. 

The  agitation  of  the  question  of  medical  edu- 
c  ition  is  bearing  fruit,  however,  in  that  a  major- 
ity of  the  schools  situated  in  the  northern 
States  demand  at  the  present  time  evidence  of 
preliminary  fitness  before  matriculation,  and 
that  in  a  period  of  five  years  all  colleges  known 
to  the  writer  have  extended  the  period  of  time 
of  study,  with  a  change  of  the  minimum  length 
of  term  from  five  to  six  months.  After  the 
present  year  every  medical  school  of  recognized 
standing  will  require  attendance  upon  four 
courses  of  lectures  in  different  years,  of  six 
months'  duration  each  course,  before  conferring 
thedgree  of  M.D.  The  reforms  thus  far  ac- 
complished have  only  been  secured  in  the  face 
of  determined  opposition  at  the  hands  of  the 
representatives  of  the  low  grade  institutions. 
Future  opposition  will  result  in  disaster  to  the 
p  irticipants.  Professional  sentiment  is  de- 
cidedly with  those  schools  now  operating  under 
the  advanced  curricula.  This  is  particularly 
manifested  by  the   increased  number  of  matri- 

*  Read  Before  the  American  Academy  of  Medicine 
at  Baltimore,  May  6,  1895. 


198 


THE  CANADA  MEDICAL  RECORD. 


culates  in  the  last  three  years  at  schools  operat- 
ing under  the  four  years'  course.  The  fiscal 
matriculation  at  the  University  of  Pennsylvania 
and  Columbia  is,  approximately,  eight  hundred, 
Harvard  five  hundred,  and  others  in  proportion  ; 
while  that  of  the  recognized  low-grade  institu- 
tions have  sensibly  fallen  off. 

Notwithstanding  the  trend  of  public  opinion, 
we  are  firmly  of  the  conviction  that  our  only 
safety  consists  in  the  establishment  of  efficient 
legislative  acts  in  substantially  every  State.  The 
high  grade  schools  are  undergoing  a  period  of 
evolution,  and  are  determined  to  inaugurate 
greater  system  in  methods  of  work  ;  with  low- 
grade  schools  little  evidence  is  at  our  command  I 
pointing  to  improvement.  1 

The  elevation  of  the  standard  of  requirements    ' 
in  the  latter    class  of  schools    have  seemingly    1 
been  entirely   in  response  to  the  requirements 
of  the  respective  State  boards  of  medical  exam-    | 
incrs. 

The  indifference  of  the  profession  to  methods 
of  medical  education  has  been  far-reaching  in 
its  pernicious  influences.  Blinded  by  our  own 
shortcomings,  we  did  not  awaken  to  a  realiza- 
tion of  our  environment  until  our  interests  were 
greatly  jeopardized.  We  found  ourselves  drift- 
ing, in  the  estimation  of  both  the  public  and 
profession,  towards  a  condition  of  professional 
inefficiency,  not  unlike  that  of  French  medicine 
in  the  seventeenth  century,  so  graphically  des- 
cribed by  Moliere.  One  of  the  greatest  evils  of 
our  system  was  the  flooding  of  our  ranks  with 
a  horde  of  poorly  educated  practitioners  far  in 
excess  of  our  legitimate  demands.  The  latter 
assertion  is  convincingly  illustrated  by  the  sta- 
tistics gleaned  from  the  recent  excellent  paper 
of  Professor  Pepper  on  Medical  Education, 
affording  comparative  statistics  relating  to  the 
proportion  of  practitioners  to  the  population  in 
different  countries  of  the  globe. 

TABLE  INDICATING    PROPORTION  OV    PHYSICIANS 
TO    THE  POPULATION. 

Aui-tro-llungarian  Empire i   to  3,857. 

Belgium    i   to  2,841. 

Fiance i  to  2,666. 

German  Empire i  to  3,038. 

»      Italy ...  1103,536. 

Netherlands I  to  2,484. 

Norway I  to  3,961. 

Kus-,ia I   to  8,551. 

■Spain I   to  3.375. 

United  States I  to      500. 

The.  number  of  medical  colleges  indicates  a 
similar  disproportion. 

NUMBER    OF    MEDICAL    COLLEGES   TO   THE    POPU- 
LATION. 

Austro-Hungarian  Empire...  I  to  5,153.917. 

Belgium i  to   1.53.1,111. 

Brazil i  to  7,f)Oi,i67. 

Canada i  to  3,336,877. 


Ciiili I   to  2,887,552. 

France i   to  5,477,591. 

German  Empire i   to   2,471,923. 

Great  Britain i   to  2,358,767. 

Italy I   to  1,445,109. 

Netherlands i  to      660,249. 

Norway - i   to   1,988,771. 

Sweden i   to  1,600,917. 

Russia      I  to   14,403,317. 

Spain I  to  1,950,027. 

United  States 1   to      440,151. 

It  will  be  observed  from  the  above  that  the 
proportion  of  practitioners  and  the  number  of 
schools  are  greatly  in  excess  of  other  countries. 
Medical  colleges  in  foreign  countries  are  like- 
wise independent  financially,  being,  as  a  rule, 
directly  supported  by  the  State,  or  possessing  a 
direct  university  connection. 

An  in\estigation  of  this  subject  revealsbeyond 
the  possibility  of  successful  controversion  that 
the  most  efficient  profession  is  found  in  those 
countries  protected  by  efficient  legislation ; 
while  a  correspondingly  low  standard  of  pro- 
fessional fitness  exists  in  countries  not  simik.rly 
protected. 

At  one  time  considerable  opposition  existed 
to  the  regulation  of  medical  piactice  by  legisla- 
tive enactments.  With  the  defeat  of  attempts 
to  destroy  the  effects  of  this  form  of  legislation 
by  litigation  and  the  moral  supi)ort  afforded  by 
the  recent  decision  of  the  Supreme  Court  of  the 
United  States  and  Supreme  Courts  of  the  several 
States,  as  well  as  the  apparent  benefits  from  the 
successful  operations  of  the  law  in  a  large  num- 
ber of  Slates,  it  is  pleasing  to  note  a  decided 
change  of  sentiment  in  favor  of  this  form  of 
legislation. 

The  existing  opposition  to  this  form  of  legis- 
lation is  greatly  disappearing,  being  greatly 
confined  at  present  to  the  charlatan,  the  facul- 
ties of  a  few  of  our  low  grade  schools  and  the 
]niblic  press.  We  can  trace  the  existence  of 
statutes  regulating  medical  practice  fiom  the 
thirteenth  century;  in  the  year  1237,  licenses 
were  only  obtainable  in  Italy  upon  attendance 
at  medical  lectures  for  a  period  of  five  years, 
with  preliminary  entrance  requirements  de- 
manding three  years'  work  in  philosophy. 

The  first  degrees  in  medicine  were  evidently 
conferred  in  Italy  in  1384.  Laws  regulating 
medical  practice  have  existed  in  all  civilized 
countries  for  many  centuries.  It  is  unfortunate 
that  in  this  country  the  diploma  has  been 
given  a  legal  interpretation  ;  in  foreign  coun- 
tries it  is  simply  an  evidence  of  scientific  value. 
With  the  advent  of  statutes  regulating  medical 
practice  this  custom  upon  the  part  of  the 
courts  is  becoming  abrogated.  We  cannot 
but  conclude  that  in  the  older  countries  we 
have  a  superior  profession  in  jjoint  of  intelli- 
gence, with  a  more  desirable  environment  ; 
while  with  us  we  have,  as  a  whole,  men 
somewhat  inferior  in  their  preliminary  training, 


THE   CANADA    MEDICAL   RECORD. 


199 


a  number  triple  ihat  of  any  other  country  and 
a  professional  environment   most  undesirable. 

The  essentials  of  eflicient  medical  legislation 
will  incoiporate  the  following  features: 

(i)  The  adoption  of  more  rigid  rules 
governing  the  admission  of  students  to  medical 
schools. 

(2)  The  deleriiiination  of  the  applicant's 
fitness  to  practice  by  an  examination  upon  a'l 
the  branches  of  medicine. 

(3)  The  right  to  refuse  or  revoke  licenses 
for  unprofessional  or  dishonorable  conduct. 

(4)  An  adequate  penalty  for  violation  of  the 
provisions  of  this  varietv  of  legislation. 

(5)  The  boards  of  exammers  to  be  appoint- 
ed by  the  Governor,  with  proi)ortionate  rei)re- 
sentation  by  different  schools  of  practice.  In 
support  of  demands  for  an  adequate  entrance 
requirement,  it  is  conceded  that  medicine  is 
now  more  nearly  practised  from  a  scientific 
basis  than  at  any  time  ir/  its  history.  Without 
jdeqiiate  i)reliminary  fitness,  the  broad  field 
cannot  be  grasped  nor  its  practice  entrusted  to 
persons  without  well  trained  minds. 

Persons  contemplating  medicine  as  an  avo- 
cation should  give  the  scientific  branches  par- 
ticular attention  in  preparation.  A  thorough 
course  in  the  scientific  department  of  our 
better  equipped  colleges  or  universities  will 
permit  of  the  successful  accomplishment  of  the 
course  now  provided  in  the  four  years'  curri- 
cula in  a  period  of  three  years.  I  fully  concur 
in  the  position  taken  by  Professor  Vaughan, 
however,  in  that  the  classical  course  does  1  ot 
prepare  the  student  in  a  manner  that  he  can 
safely  abridge  the  work  now  required  in  the 
four  years'  curricula.  The  necessity  of  a 
thorough  college  training  is  more  apparent 
now  than  at  any  previous  time.  While  an 
immediate  attempt,  looking  to  the  demand  as 
above  suggested,  would  probably  meet  with 
defeat,  1  am  of  the  opinion,  however,  that  by 
concert  of  action  we  can  secure  the  adoption 
at  this  time  of  an  elevation  of  the  standard  of 
fitess,  requiring  a  college  or  university  matri- 
culation, or  its  equivalent,  of  all  students 
wishing  to  commence  the  study  of  medicine. 
If  the  student  cannot  furnish  a  matriculation 
ticket  from  a  recognized  college  or  university, 
he  or  shi  should  be  required  to  undergo  an 
examination  that  would    admit  to  such  course. 

Under  existing  relations  we  cannot  safely 
entrust  this  examination  to  the  representatives 
of  the  teaching  body.  Except  in  a  few  of  our 
liigh  grade  schools  the  entrance  examination 
has  been  a  farce  as  at  present  conducted.  The 
factors  leading  to  this  condition  are  the  same 
as  outlined  earlier  in  this  paper.  It  is  the 
result  of  college  competition  with  an  unneces- 
sary multiplication,  in  recent  years,  of  the 
number  of  teaching  bodies.  It  is  my  judgment, 
based  upon  a  somewhat  varied  and  extended 
experience,  that  the  majority  ot  the  schools  in 


this  country  exists  to  serve  the  personal  in- 
terests of  the  respective  faculties  rather  than  to 
serve  the  legitimate  demands  of  the  people. 
About  twenty-five  per  cent,  of  our  schools  have 
a  matriculation  of  less  than  sixty  pupils. 

The  determination  of  the  fitness  of  the 
students  to  commence  the  study  of  medicine 
should  be  placed  in  the  hands  of  a  body  of  men 
entirely  disinterested.  I  know  of  no  body 
better  qualified  to  superintend  the  execution  of 
this  important  trust  than  a  State  board  ot 
medical  examiners.  If  not  such  a  body, 
then  a  committee  composed  of  members  ot  a 
fiiculty  of  a  college  or  univer.^ity. 

The  minimum  of  entrance  requirements  should 
be  uniform  between  the  different  States.  Under 
the  operations  of  the  New  York  law  regulating 
the  examination  of  students  commencing  the 
study  of  medicine,  much  good  is  being  accom- 
plished. I  desire  to  urge  upon  the  prufe-^sion 
the  necessity  of  provisions  i  i  fuuire  acts  look- 
ing to  a  rigid  protection  of  the  gateway  to  the 
study  of  medicine. 

[To  be  Continued.) 


^ 


ocictjj     Broccct)ings 


MONTRKAL  MEDICO-CHIRURGIC AL 
SUCIEIY. 

Stated  Meeting  Dec.  28,   1894. 

G.   P.  GiRDWOOD,  M.  D.,  Presfdent,  i.v  the 
Chair. 

Dr.  J.  C.  Camerojj,  speaking  in  regard  to 
the  treatment,  said  the  proper  course  to  pursue, 
in  these  cases  depends  (i)  upon  where  the  ar- 
rest has  taken  place — whether  it  is  at  the  brim, 
or  whether  it  is  low  down;  (2)  whether  the 
liquor  amnii  is  present,  whether  it  has  only  a 
short  time  escaped,  or  whether  it  has  been  long 
drained  away.  When  the  arrest  is  high  up  (at 
or  ab^ve,  the  brim)  which  is  a  common  occur- 
rence, and  the  hand  can  be  introduced,  the 
manual  breaking  up  of  the  wedge  is  indicated. 
He  did  not,  ho>vever,  think  it  necessary  to  pass 
the  hand  up  as  far  as  the  fundus  for  this  pur- 
pose ;  by  passing  the  fingers  along  the  pos- 
terior surface  of  the  thighs,  the  flexure  of  the 
knees  could  be  reached,  then  abduct  the  limb, 
pressing  at  the  same  time  on  the  thigh,  and  the 
leg  will  generally  fall  into  the  operator's  hand. 
This  treatment,  known  as  Pinard's  manceuvre, 
is  also  indicated  when  sufficient  liquor  amnii  is 
present  to  permit  the  introduction  of  the  hand. 
When,  however,  the  breech  has  descended,  or 
when  the  liquor  amnii  has  all  dr  lined  away, 
leavmg  the  uterus  contracted  round  the  foetus, 
it  may  be    impossible  to   introduce  the  hand 


200 


THE   CANADA   MEDICAL   RECORD. 


sufficiently  to  make  sucn  manipulations;  the 
forceps  arc  then  indicated.  The  nllet  and  nook 
are  apt  to  do  too  much  injury  to  warrant  their 
use.  Tarnier's  Axis  Traciion  Forceps  are  the 
best  for  such  cases,  the  blades  being  introduced 
so  as  to  grasp  exactly  ihc  lateral  diameter  of 
the  breech.  If  care  is  taken  as  to  the  direction 
in  which  traction  is  made,  Dr.  Cameron  thought 
slipping  not  so  likely  to  occur.  It  is  the  posi- 
tion of  the  arms  after  all  that  constitute  the 
real  difficulty  in  such  cases.  If  they  happen 
to  be  flexed  outside  the  legs,  or  if  the  elbows 
project,  delivery  is  almost  impossible. 

Dr.  Geo.  Brown,  in  reply  to  Dr.  Cameron, 
thought  it  made  very  little  difference  once  one 
succeeued  in  gettingthe  hand  inside  the  uterus, 
which  method  was  adopted,  provided  the  oper- 
ator delivered  a  leg,  the  difficulty  being  in  get- 
ting the  hand  in.  He  had  very  little  faith  in 
the  use  of  forceps  in  such  cases  ;  he  found  that 
jio  matter  how  accurately  applied,  or  how  well 
fitted,  slipping  occurred  or\  the  least  force  be- 
ing uted.  It  was  only  to  be  expected,  as  the 
blades  could  not,  from  the  nature  of  the  case, 
get  a  secure  hold  of  the  breech.  Moreover,  if 
Tarnier's  forceps  were  used,  and  a  lot  of  trac- 
tion exercised,  fracture  of  the  child's  ilia  would 
almost  certainly  result. 


Stated  Meetiuii ,  wih  January ,  1 895 . 

].  B.  McCoNNELL,  M.D.,  First  Vice-Presi- 
dent,  IN  THE   ChAIK. 

Dr.  R.  A.  Bowie,  of  Brockville,  was  elected 
an  ordinary  member. 

Denth  from  Chio'  ojorm. — Dr.  J  AMES  Bell 
reported  this  case  as  follows  : — 

Mrs.  T.,  set.  30,  suffering  from  cerebral 
tumor  involving  the  lower  portion  of  ihe  left 
motor  area,  was  prepared  for  operation  Decem- 
ber 6th,  1894.  The  administration  of  chloro- 
form was  begun  at  2  p.m.  by  Dr.  Davidson, 
with  Dr.  Fry  wa'ching  the  radial  pulse. 
Chloroform  was  given  on  an  Esmarch's  wire 
mask,  covered  with  thin  stockinette.  From 
^rst  to  last  the  amount  of  chloroform  which 
escaped  from  the  bottle  was  seven  drams,  but 
on  two  occasions  the  bottle  was  upset  and 
some  of  its  contents  spilled.  The  seven  drams, 
therefore,  represent  not  only  the  chloroform 
which  was  ])oured  upon  the  mask,  but  the 
quantity  which  was  si)ilied  on  the  two  occa- 
sions above  referred  to.  The  whole  period 
during  which  chloroform  was  administered  was 
thirty-three  minutes.  The  patient  passed  quietly 
into  the  anaesthetic  state  without  any  unusual 
or  untoward  symptoms.  At  2.30  the  pulse 
was  100,  respiration  28,  pupils  contracted. 
At  2.35  lines  were  drawn  on  the  shaven  scalp 
with  the  scalpel  to  indicate  the  position  of  the 


Rolandic  and  Sylvian  fissures.     These  incisions 
were  very  superficial,  but  the  patient  struggled 
a  little,  showing   that  she   was  not  then  fully 
ar.asslhetized.      It  was  also  remarked  that  there 
was  very   litije  bleeding  from  these  slight  in- 
cisions.    (I  am  now  inclined  to  attach  some 
importance  to  this  fact.)     From  this  time  30 
drops  of  chloroform  were   dropped    upon  the 
mask,   TO  drops  at  a  time.     At  2.39  the  pulse 
stopped  suddenly  and  without  warning.     Six 
respiratory  movements  occurred  after  ihe  pulse 
ceased  to  be  felt, — at  first  full  and  strong— ar.d 
gradually  diminishing  until    they    ceased  alto- 
gether.    There  was  then    full   dilatation  of  the 
pupils,  and  general  lividity  developed  rapidly. 
The  patient  was  inverted,  hot  applications  were 
applied  to  the   precardium,     the   tongue    was 
drawn  forward   and  artificial    respiration  car. 
ried  on  for  fifteen  minutes,  when  respiration 
was  restored.     Six  natural  respirations  occurred 
in    a   minute,    during    which  the    lividity  was 
decreased  considerably.     The  pulse  could  not 
be  felt,  but  some  cardiac  movement  could  be 
recognized  by  Dr.  Stewart  with  the  stethescope. 
Willi  the  return   of  respiration  I  began   to  feel 
that  the  danger  had  passed,  but  at  the  expira- 
tion of  one  minute  respiration  became  slow  and 
shallow.     Artificial    respiration    was  resumed, 
1-50  gr.  of  strychnia  was  given  hypodermically 
and    three  capsules  of  amyl    nitrate  (5   min- 
ims each)  were  applied    to    the  nostrils.     At 
this  time,  however,  respiration -had  practically 
ceased,  so  that  the  amyl  nitrate  had  probably 
no    effect    whatever.     Respiration    ceased  en- 
tirely and  deep  lividity  supervened.     Restora- 
tive measures  were  abandoned  at  2.58. 

At  the  raitopsy,  seven  hours  after  death,  all 
the  chambers  of  the  heart  were  found  moder- 
ately full  of  blood,  the  brain  tumor  was  found 
to  be  an  infiltrating  sarcoma,  diffused  over  a 
wide  area  of  the  left  hemisphere  with  secondary 
nodules  in  the  peritoneum, — an  inoperable 
growth. 

The  coroner  was  notified  and  an  inquest 
held,  the  result  being  a  verdict  fully  exonerating 
the  hospital  and  all  concerned. 

In  this  case,  which  was  carefully  observed 
throughout,  death  very  clearly  began  at  the 
heart,  and  also  very  clearly  was  not  due  to  over- 
dosage, which,  I  believe,  is  a  much  more  fre- 
quent cause  of  death  in  chloroform  administra- 
tion than  is  generally  recognized.  In  cases  of 
death  from  over  dosage,  moreover,  the  respira- 
tory function  is  the  first  to  fail,  and  the  wide- 
spread belief  that  chloroform  frequently,  if  not 
generally,  kills  through  arrest  of  the  respiratory 
function  is,  in  my  oi)inion,  largely  based  ui)on 
the  observation  of  such  cases.  This  was  a  con- 
spicuous fallacy  in  the  experiments  of  the 
Hyderabad  Commission.  They  chloroformed 
several  dogs  to  death  (over-dosage).  These 
dogs  all  died  through  arrest  of  respiratory 
function,    and   upon    those    experiments    the 


THE   CANADA   MEDICAL   RECORD. 


20I 


Commission   laid    down    the  rule    that   deaths 
from  chloroform  always  occurred  in  this  way, 
entirely  ignoring  such  cases   as   the  one  here 
reported.     Throughout  the    whole    history   of 
chloroform  as  an  anoeslhetic,  cases  of  sudden 
death   have    occurred    from   time    to    lime  in 
patients  with  sound  organs,  often  during  slight 
operations  or  before  operation  was  begun,  and 
at  an  early    period    of  anaesthesia,    in    which 
arrest  of  heait's  action  and  cessation  of  respira- 
tion were  noted  at  the  same    moment,  or  in 
which    the    arrest  of   heart's  action    was    first 
noticed.     Now,   it  must  be  borne  in  mind  that 
in  strangulation,  asphyxia  or  jiaralysis  of  the 
respiratory     centre,     causing    complete   cessa- 
tion of  respiration,  the  heart's  action  continues 
and  the  radial  pulse  can   be  felt  for  an  appre- 
ciable space  of  time — often  for  some  minutes. 
On  the  contrary,  sudden    and   complete  arrest 
of  the  heart's  action  is  immediately  followed 
by  cessation    of   respiration.     It  is,  therefore, 
highly  [jrobable  that  when  pulse    and    re.>])ira- 
tion  appear  to  fail  at  the  same  moment,  ihe 
primary  failure  is  in  the  heart.     The  fact  al- 
ready noted,    that    the    slight    incisions  in  the 
scalp  bled  only  slightly,  has   led   me    to  think 
that  perhaps   there  was,  even  then,  some  inhi- 
bitory process   at  work  affecting  the  capillary 
circulation,    and   apparently    beginning  at  the 
peripheiy,  as  the  pulse  was  still  full,  strong  and 
regulac.     Besides,    the    heart    failure    was    not 
comi>lete,  when  the  radial  pulse  first  became  so 
weak  as  to  be  inappreciable,  as    cardiac  move- 
ments were  recognized  later,  and  there  was  a 
return  of  respiration   for  a  little   more  than  a 
minute. 

Dr.  James  Stewart  remarked  the  cause  of 
death  was  heart  failure.  '1  his,  he  believed, 
was  the  usual  cause,  according  to  the  investi- 
gations made  in  this  country  and  in  Great 
Britain.  Surgeon  Laurie  had  made  various 
attempts  to  prove  that  death  was  due  to  respir- 
atory paralysis  ;  but  since  his  paper  on  this 
subject  in  connection  with  the  Hyderabad 
Commission  appeared,  many  others  have 
closely  investigated  the  subject,  and  almost 
all  agree  that  death  takes  place,  not  through 
the  respiratory,  but  through  the  cardiac  centre. 
The  matter  is  of  special  importance,  as  Laurie's 
teaching  is  now  so  widespread  that  the  ad- 
ministrator is  led  to  pay  greater  attention  to  the 
respirations,  to  the  neglect  of  the  pulse  ; 
whereas  in  reality  it  is  the  latter  which  should 
be  the  more  closely  watched  as  the  source  of 
danger. 

Dr.  Gordon  Campbell  thought  that  in 
the  case  under  discussion  there  must  have 
been  some  recovery  of  the  heart,  temporarily 
at  all  events.  Dr.  Bell  said  that  after  the 
stoppage  of  the  heart  the  lungs  continued  act- 
ing for  six  or  eight  respirations,  then  they  also 
ceased  and  the  patient  became  very  livid. 
However,  after    artificial  respiration   and  other 


restorative  measures  had  been  adopted,  the 
patient  again  began  breathing  naturally,  an! 
after  a  certain  number  of  full  respirations  the 
lividity  became  diminished  and  the  appearance 
of  the  i)atient  so  far  improved  as  to  lead  Dr. 
Bell  to  believe  all  was  well.  This  improve- 
ment could  not  occur  from  the  mere  teraiion  of 
the  blood  in  the  lungs.  To  relieve  the  con- 
gestion of  the  peripheral  circulation  the  heart 
must  have  acted  also,  and  on  this  account  Dr. 
Campbell  believed  that  here  at  least  the  initial 
paralysis  of  the  heart  was  not  final  or  per- 
manent. 

Dr.  McCoNNF.LL  remarked,  that  according  to 
a  report  of  some  investigations  recently  un- 
dertaken in  the  United  States  by  Hare  and 
Thornton,  the  Hyderabad  theory  was  con- 
firmed, and  death  did  seem  to  occur  through 
respiratory  failure. 

Dr.  Blackader  said  that  the  present 
oi)inion  of  investigators  with  regard  to  the 
action  of  chloroform  in  animals,  especially 
dogs,  was  that  its  first  toxic  effect  was  not  upon 
the  heart,  but  upon  the  respiratory  and  vaso- 
motor systems.  He  thought  this  view  must  be 
now  generally  adopted.  Its  action  upon  man, 
however,  seemed  occasionally  to  differ  from  . 
this.  From  the  clinical  reports  of  several  fatal 
cases  it  seemed  to  have  been  shown  that  chloro- 
form clearly  in  certain  cases  had  a  primary 
toxic  action  upon  the  heart  in  man.  He 
thought  these  contradictory  results  might  be 
reconciled  by  the  fact  that  the  former  dealt 
with  lower  animals  in  a  healthy  condition, 
whereas  the  latter  had  to  do  with  the  human 
species,  and  often  where  pathological  con- 
ditions existed. 

Dr.  James  Bell  said  that  in  accepting  the 
results  of  these  experimenters  we  must  not 
lose  sight  of  the  fact  that  although  the  usual 
mode  of  death  from  a  narcotic  drug,  such  as 
chloroform,  ether  or  opium,  may  be,  and  v(  ry 
likely  is,  through  t-he  res|)iratory  centres  in 
cases  such  as  he  had  now  reported,  the  death 
is  not  the  result  of  the  narcotic  qualities  of 
the  drug,  but  is  something  which  occurs  once 
in  abou't  three  thousand  times,  or  perhaps  only 
once  in  fifty  thousand  times.  The  experiments 
alluded  to  have  never  gone  beyond  a  couple 
of  hundred  cases,  and  therefore  were  not  likely 
to  meet  with  this  special  result  of  chloroform. 
He  believed  it  very  Hkely  that  where  death  was 
produced  by  narcotic  action  of  the  drug,  it 
occurred  through  the  respiratory  centres,  and 
he  had  no  doubt  at  all  that  accidents  often 
arose  from  an  overdose  of  chloroform  given  by 
a  careless  administrator.  He  had  seen  in- 
stances of  such  accidents  himself  where,  though 
th.ey  did  not  end  fatally,  they  might  have  done 
so.  The  point  is,  however,  that  once  in  a  cer- 
tain number  of  cases  where  you  least  expect  it, 
in  minor  operations,  or  even  before  the  opera- 
tion has  begun,  where  only  a  little  of  the  drug 


202 


THE   CANADA   MEDICAL   RECORD. 


has  been  given  and  where  every  possible  pre- 
caution has  been  taken,  cardiac  failure  super- 
venes and  is  not  recovered  from,  whereas  in 
other  cases  it  is  recovered  from.  He  reported 
a  rase  last  summer  of  a  boy  whose  pulse 
siop])ed  and  gave  him  a  great  scare,  but  who 
fully  recovered.  In  the  present  case  Dr. 
Bell  ihoight  the  fact  that  so  little  bleeding 
followed  his  preliminary  scratching  of  the  scalp, 
a  region  where  bleeding  should  be  profuse,  was 
of  considerable  significance.  This  took  place 
four  minutes  before  the  heart  stopped,  and 
might  go  to  show  that  even  then  there  was 
SI. me  inhibitory  process  at  work  in  the  circu- 
lation at  its  distal  extremity  which  travelled 
towards  the  centre.  This  was  to  him  a  new 
ihought,  as  he  had  not  been  accustomed  to 
think  of  the  arrest  of  the  heart's  action  being 
biought  about  in  that  way,  from  the  periphery 
towards  the  centre  ;  still,  he  was  confident  the 
scratches  he  made  in  the  scalp  did  not  bleed  as 
they  should  have  done,  and  their  not  doing 
so  he  believed  of  some  significance. 

Dr.  Elder  recalled  the  objection  made  by 
I-r.  Campbell.  He  could  not  believe  that  the 
mere  aeration  of  the  blood  in  the  lungs  could  so 
affect  the  lividity  of  the  general  surface  as  to 
lead  Dr.  Bell  to  think  everything  was  coming 
light. 

Dr.  Lafleur  asked  if  rythmic  traction  on 
the  tongue,  after  the  method  used  by  Laborde 
and  in  great  favor  with  the  Parisian'^,  had  been 
tried. 

Dr.  J  AS.  Bell,  in  answer  to  Dr.  Elder,  re-read 
the  portion  of  his  written  report  bearing  on 
this  point.  He  further  said,  the  apparent 
recovery  was  r.ever  so  complete  as  to  give 
them  any  hope  of  resuming  the  operation  ;  the 
cardiac  impulse  never  returned.  Dr.  Lafleur 
he  answered  in  the  negative. 

Dr.  Mills  believed  that  though  Dr.  Camp- 
bell's point  had  been  well  taken,  it  might  be 
pressed  too  far.  Very  few  people  properly 
estimated  the  importance  of  the  respirations  on 
the  venous  circulation  ;  thus,  lo  dilate  the 
lungs  was  to  enlarge  the  arterioles,  and  to  allow 
blood  to  get  out  of  the  right  heart,  and  some 
to  take  its  place,  so  that  it  is  not  impossible  to 
uaderstand  how  a  certain  amount  of  lividity 
might  disappear  were  the  heart  beating  ever  so 
faintly.  He  thcAight  the  investigations  hereto- 
fore had  been  conducted  on  far  too  narrow  a 
basis,  and  the  conclusions  drawn  from  alto- 
gether insufficier.t  djta.  He  thought  the 
exi)eriii  ents  of  Gaskell  and  Shore  proved  that 
the  heart  may  not  only  fail,  but  fail  early. 
With  reference  to  Dr.  Bell's  suggestion  of  some 
failure  of  the  jjeripheral  circulation  first,  it  is 
l)05sible  to  understand  some  derangement  of 
the  vaso-motor  cinlies  by  which  great  dilatation 
oft  e  vessels  of  one  regie  n  may  take  place, 
while  the  heart  still  beats,  causing  a  corres- 
ponding anaemia  in  other  parts.     T'he   vessels 


of  the  abdominal  area,  for  instance,  may  be  so 
dilated  as  to  surk  up  all  the  blood  of  the  body, 
and  thtre  would  then  be  practically  no  circula- 
tion elsewhere.  Other  points  which  he  thought 
Dr.  Bell  might  have  laid  more  emphasis  upon 
were:(i)  the  fact  that  the  surgeon  is  dealing 
with  individuals  diseased,  or  at  least  not  perfect- 
ly normal  as  to  he  dth,  whereas  the  experimen- 
ters dealt  with  animals  generally  in  good  health  ; 
(2)  the  influence  of  i)sychic  impressions  of 
dread,  which,  existing  in  the  minJ  and  kept 
under  control  during  perfect  consciousness, 
may  be  revived  in  thiir  full  force  as  the  indivi- 
dual sinks  under  the  influence  of  the  drug. 
Something  akin  to  this  is  seen  in  iiypnotism, 
where  impressions  made  in  one  slate  of  con- 
sciousness were  revived  arid  acted  upon  in 
another  ;  (3)  there  were  the  special  peculiarities 
of  the  heatt  muscle  itself  to  consider.  This 
was  seen  in  the  fact  that  we  may  act  with 
chlorofoim  upon  hearts  completely  severed 
from  their  nervous  connections,  and  get  results 
as  diverse  and  inexplicable  as  when  we  act  upon 
the  heart  in  situ 

Dr.  Bl.ackader  remarked  so  far  as  pharma- 
cologists were  concerned,  he  believed  he  was 
justified  in  stating  their  opinion  to  he  that  the 
experiments  of  Gaskell  and  Shore  were  alto- 
gether too  complicated  to  be  relied  upon. 

Dr.  Adami  agreed  with  Dr.  Blackader  that 
the  work  and  experiments  of  Gaskell  were  very 
complicated.  Nevertheless  in'  some  cases 
where  the  ex|)eriment  came  off  successfully,  the 
results  were  'Striking,  as  instanced  in  the  case 
of  the  cross-ligatures  and  anastomosis  per- 
formed between  two  dogs,  so  that  the  blood  of 
one  dog  exclusively  supplied  the  cerebral  ves- 
sels of  the  other,  while  his  own  cerebral  vessels 
received  their  supply  from  the  other.  They 
then  chloroformed  one  of  them,  and  as  a  result 
of  the  cross  anastomosing,  the  dog  who 
received  the  chloroform  had  his  brain  supplied 
with  pure  blood,  while  the  dog  who  did  not 
inhale  it  had  his  cerebral  blood  supply  charged 
with  ihe  drug.  In  some  of  these  ex[jeriments 
it  was  found  that  the  animal  inhaling  the  drug, 
although  his  nerve  centres  were  supplied  with 
pure  blood,  died  of  heart  failure,  that  showing 
that  chloroform  had  a  diiect  action  upon  the 
heart  itself  Some  experiments  of  his  own 
were  in  the  same  line.  He  found  that  when 
certain  quantities  of  chloroform  were  given, 
sudden  and  great  dilatation  of  the  chambers  of 
the  heart  followed  ;  this  occurred  so  rapidly  as 
to  .'eeni  as  though  we  had  here  an  action  upon 
the  muscle  fibres  themselves,  or  upon  the  fine 
nerve  endings  (which  Berkley  and  others  have 
now  shown  to  be  more  common  than  supposed 
hitherto),  rather  than  upon  the  nerve  centres  in 
the  brain  or  cord.  Dr.  Adami  thought  the 
coi>clusion  to  be  drawn  from  the  observations 
of  Gaskell  and  Shoie  wa;;  that  chloroform  could 
act  directly  ui)on  tlie  heart. 


THE   CANADA   MEDICAL   RECORD. 


203 


Dr.  WiLKiNS  believed  the  untoward  action 
of  chloroform  in  cases  like  that  under  discus- 
sion was  in  the  heai  t  muscle  itself,  and  gave  his 
reason  as  follows  :  some  years  ago,  when  per- 
forming experiments  upon  animals,  he  frequent- 
ly had  stoppage  of  the  heart  occur  among 
dogs,  which  he  was  able  to  resuscitate  after- 
wards by  artificial  respiration.  This  resuscita- 
tion proved  the  action  to  have  been  upon  the 
heart  itself,  because  the  cardiac  and  respira- 
tory centres  being  close  to  each  other  in  the 
medulla,  if  the  lesion  was  central,  recovery 
could  not  take  i)lace  in  such  a  short  space  of 
time.  Most  of  the  member?  would  remember 
those  drowning  experiments,  where  dogs  were 
submerged,  some  with  corks  in  their  trachse, 
some  v/ithout ;  the  former  were  capable  of 
being  resuscitated,  as  they  could  properly 
aerate  their  blood  and  the  heart  resumed  its 
action,  the  latter  were  not.  In  collapse  from 
chloroform,  if  artificial  respiration  were  kept 
up  for  three  or  four  minutes,  the  heart  might 
resume  its  action,  shewing  the  collapse  to  have 
been  the  result  of  the  action  of  the  drug  upon 
the  heart  muscle  itself  rather  than  upon  the 
cardiac  or  respiratory  centres. 

Dislocation  of  the  Ninth  Dorsal  Vertebra 
treated  by  Extension. — Dr.  Armstrong 
showed  a  man  in  whom  he  had  successfully 
reduced  a  dislocation  of  the  dorsal  ver-. 
tebra.  The  patient  was  brought  into  the 
hospital  with  what  appeared  to  be  a  frac- 
ture and  dislocation  of  the  eighth  or  ninth  dor- 
sal vertebra.  The  accident  occurred  in  the 
following  way  :  The  man  driving  under  a  gate- 
way on  top  of  a  load  got  himself  jammed  be- 
tween the  latter  and  the  arch.  There  was  no 
evidence  of  destruction  of  the  cord  at  that  time, 
he  could  move  his  legs,  etc.,  and  sensation 
seemed  normal ;  but  his  body  was  doubled  up, 
bent  much  forward  and  he  was  unable  to 
straighten  himself.  A  depression  was  observed 
at  the  point  of  injury  and  the  supra-spinous 
ligament  seemed  broken.  He  put  the  patient 
under  an  anaesthetic,  had  a  large  pillow  placed 
under  his  abdomen,  and  with  the  assistance  of 
two  men  attempted  extension  and  reduction. 
To  his  great  suprise  the  dislocation  was  reduced 
almost  at  once,  slipping  right  in,  the  two  ver- 
tebrae came  together,  and  the  depression  and 
deformity  disappeared.  The  man  felt  quite 
relieved  upon  coming  out  of  the  chloroform, 
and  although  seven  weeks  had  passed  he  had 
had  no  bad  symptoms  since.  From  this  experi- 
ence he  would  therefore  advise  surgeons  always 
to  try  extension  of  the  spine  with  manipulation 
of  the  vertebrse  before  proceeding  to  operate, 
no  matter  what  their  previous  experience  of  such 
cases  may  have  been. 

Arthrectotny. — Dr.  Armstrong  showed  a 
man  upon  whom  he  had  performed  arthrec- 
tomy  about  a  year  before.  The  patient  had 
been    exhibited    sliortly    after    the  operation, 


when  only  slight  motion  in  the  joint  was 
present;  now,  however,  it  was  capable 
of  a  great  deal  more.  The  ojieration  con- 
sisted of  opening  the  knee-joint  and  remov- 
ing the  articular  surfaces  of  both  condyles  and 
a  portion  of  the  tibia.  He  had  cut  across  the 
patella,  which  was  united  by  ligamentous  union. 
The  case  was  one  of  caries  sicca,  with  marked 
atrophy  of  the  muscles.  The  object  in  bring- 
ing him  again  was  to  show  how  much  improve- 
ment had  taken  place  since  the  operation. 
The  man  had  been  working  on  a  cattle  ship 
all  summer,  and  enjoyed  apparently  a  very  use- 
ful limb. 

Dr.  Mills  mentioned  a  case  which  he  had 
seen  in  Baltimore  a  short  time  ago,  under  the 
care  of  Dr.  A.  W.  Clement.  It  was  dislocation 
in  the  horse  of  the  middle  cervical  vertebrse, 
the  deviation  from  a  straight  line  being  so 
great  that  the  neck  had  the  shape  of  a  bent  arm, 
and  yet  there  never  had  been  a  symptom  refer- 
able to  the  nervous  system. 

Dr.  Adami  reminded  the  Society  that  to  a 
Montreal  physician,  the  late  Dr.  Campbell, 
belongs  the  honor  of  what  was  believed  to  be 
the  first  case  of  successful  reduction  of  disloca- 
tion of  the  cervical  vertebrse.  Dr.  Campbell, 
while  making  his  rounds,  observed  a  child  to 
fall  from  a  tree,  noticed  the  characteristic  atti- 
tude of  the  body  on  the  ground,  pulled  upon 
the  head  and  brought  the  parts  back  into  origi- 
nal position  immediately. 

Dr.  Jas.  Bell  said  he  believed  Dr.  Camp- 
bell's case  to  be  true.  He  himself  saw  a  case 
of  undoubted  dislocation  of  the  cervical  verte- 
bra;, without  any  symptoms  of  pressure  on  the 
cord.  On  first  seeing  him  the  patient  refused 
to  take  an  ansesthetic.  On  the  following  day, 
while  undergoing  an  examination,  in  turning 
his  head  from  side  to  side,  suddenly  his  neck 
shot  back,  and  he  was  as  well  as  ever.  It 
apparently  reduced  itself  during  the  slight 
manipulation.  Dr.  Bell  always  felt,  there  was 
danger  of  doing  serious  injury  to  the  cord  in 
attempting  to  reduce  a  dislocation  ;  it  was  hard 
to  imagine  how  one  in  the  dorsal  region  could 
be  reduced  without  injuring  the  cord. 

Scurvy  in  Children  tvith  notes  on  two  Cases. — 
Dr.  A.  D.  Blackader  read  a  paper  on  this 
subject  as  follows,  : — 

It  is  only  recently  that  the  symptoms  of 
scurvy  in  children  have  received  recognition  by 
the  profession  in  America.  Scarcely  a  twelve- 
month ago,  Dr.  Northrup  of  New  York,  pre- 
vious to  the  presentation  of  a  paper  on  this 
subject  before  the  New  York  Academy  of  Medi- 
cine, wrote  letters  to  physicians  in  various 
parts  of  the  States  and  elsewhere,  asking  their 
experience  with  infantile  scurvy.  Along  with 
others  I  was  asked  to  communicate  what  I 
could,  either  from  my  own  personal  experience, 
or  from  that  of  my  confreres.,  in  reference  to  the 
prevalence  of  this  disease  in  Montreal.     I  had 


204 


THE  CANADA   MEDICAL   RECORD. 


to  reply  that  personally  I  had  not  up  to  that 
date  recognized  a  case,  and  careful  enquiries 
made  from  many  connected  with  the  larger  of 
our  English  and  French  hospitals  and  ciiildren's 
institutions  received  everywhere  the  Sc^me 
anjwer,  that  no  cases  had  so  far  been  recog- 
nized in  Montreal. 

This  autumn,  however,  I  had  the  satisfaction 
of  seeing  two  fairly  distinctive  case?,  and  as 
the  symptoms  of  scorbutus,  unless  looked  for, 
are  liable  to  be  either  unnoticed  or  mistaken 
and  attributed  to  other  causes,  it  seerned  to  me 
thai  a  report  of  the  casrs,  with  a  siiort  review 
of  the  literature,  might  prove  of  some  interest 
to  this  ^ociety. 

My  first  case  was  seen  by  me  about  the 
middle  of  last  November.  The  infant,  12 
months  old.  ha'i  at  birth  been  a  small  but  well- 
nourished  infant,  and  for  the  first  six  weeks  was 
nursed  almost  entirely  at  the  breast.  1  hen 
the  supply  failed,  and  the  infant,  under  the 
supervision  of  the  attending  ])hysician,  was  fed 
with  a  mixture  of  milk,  barley  water  and  lime 
w.iter.  Under  this  artificial  feeding  it  failed  to 
thrive  ;  vomiting,  curdy  motions,  and  almost 
continuous  colicky  pain,  attested  the  failure  of 
digestion.  One  by  one  the  more  poi)ular 
infant  foods  received  a  trial :  Cardinal  Food, 
Lactaied  F'ood,  Neave's  Food,  Nestle's  Food, 
Horlich's  Malted  Milk,  Teptogenic  Milk  Pow- 
der. Then  the  infant  was  taken  to  the  country. 
Milk  was  again  tried,  but  failing  to  agree,  re- 
cour.se  was  had  to  Carnick's  Soluble  Food, 
which  appeared  for  the  time  to  be  digested  and 
assimilated.  J  he  child  under  this  commenced  to 
gain  weight,  the  motions  improved,  sleep  was 
more  restful,  while  during  the  day  the  infant  ap- 
peared bright  and  contenied.  About  the  first 
week  in  Cciober,  the  mother  noticed  that  the 
child  cried  on  any  attempt  to  move  the  lower 
limbs.  Shortly  afterwards,  a  swelling  was  observ- 
ed about  theright  knee,  and  later  a  bluish-colored 
s])ot  appeared  an  inch  below  the  head  of  the 
tibia.  This  was  shown  to  the  attending  physi- 
cian, who  told  the  mother  the  child  must  have 
had  a  fall,  and  prescribed  a  liniment  to  be 
rubbed  over  the  swelling.  Five  or  six  days 
afterwards  a  similar  bluish  spot  appeared  on  the 
oiherknee,  and  the  mother,  on  again  consulting 
the  physician,  was  told  that  probably  both 
knees  had  been  injured  by  the  fall,  that  acci- 
dents like  this  requited  time,  and  quietness  was 
enjoined  for  the  baby. 

Two  weeks  afterwards  the  child  was  brought 
to  my  office.  The  notes  taken  at  the  time  arc 
as  follows  :  Infant,  twelve  months  old,  rather 
small  for  its  age,  pale,  but  with  a  fair  amount 
of  subcutaneous  fat.  Head  well  shaped,  anter- 
ior fontanelle  not  abnormally  large  ;  slight  bead- 
ing of  the  ribs;  chest  well  shaped;  abdomen 
slightly  i)rominent  ;  infant  cries  at  once  on 
movement  of  the  lower  limbs.  On  the  right 
knee,  one  inch    below  the  head    of  the    tibia, 


there  is  a  bluisji-grcen  spot  of  ecchymosis 
about  the  size  cf  a  half-dollar  piece  ;  just  above 
the  joint  the  limb  appears  sliglitly  swollen, 
and  firm  and  re-isting  to  the  touch.  The  skin 
is  pale  and  cool,  but  the  surface  is  apparently 
tender.  The  circumference  of  the  limb  here  is 
3/^  inch  larger  than  that  of  the  C)rres|)onding 
limb.  Below  the  left  knee  there  is  another 
spot  of  ecchymosis  considerably  larger  than  on 
the  right  knee  ;  here  the  limb  is  tender  and 
slightly  swollen.  No  attempt  is  made  by  the 
child  to  move  the  limbs,  and  since  the  onset  of 
the  trouble,  four  weeks  ago,  the  infant  has  re- 
fused to  make  any  attempt  to  stand,  although 
previously  it  was  eager  to  do  so.  The  patellar  re- 
flexes are  active.  Another  spot  of  ecchymosis, 
about  the  size  ofa  ten-cent  piece,  is  present  on 
the  left  ear.  An  inspection  of  the  mouth  shows 
the  two  lower  incisors  cut,  but  the  gum  sur- 
rounding them  is  of  a  deep  bluish-red  color, 
bleeding  easily  when  touched.  'I'he  upper 
incisors  are  not  yet  through,  but  the  mucous 
membrane  over  them  is  reddened,  and  over  the 
edge  of  the  two  teeth  almost  through,  it  is  of 
a  dee]3  bluish  tinge.  Otherwise  the  child  ap- 
pears well.  The  tongue  is  slightly  furred,  the 
motions  are  somwhat  pale  in  color,  the  urine  is 
said  to  be  scanty,  and  the  thermometer  taken 
in  the  rectum  records  99*^   F. 

The  infant  was  ordered  to  be  given  about  a 
tablespoonful  of  fresh  orange  juice,  slightly 
sweetened,  and  diluted  with  water.  Artificial 
foods  were  stopped,  and  a  mixture  of  creamy 
fresh  milk  with  thin  barley  water  was  directed 
to  be  given.  Once  a  day  the  child  was  to  have 
a  dessertspoonful  of  the  red  juice  of  a  lightly 
broiled  steak.  The  knees  weie  to  be  kept  cov- 
ered with  cotton  wool  and  a  light  bandage. 

Three  days  later,  the  mother  reported  that 
the  infant  appeared  to  be  almost  well.  Ten- 
derness on  movement  had  passed  away,  the 
ecchymosis  had  almost  disappeared,  and  on  the 
second  night  after  the  change  in  his  food,  the 
child  passed  the  quietest  night  of  its  life.  Eight 
days  after  the  first  visit  the  child  was  brought 
again  to  my  office.  The  gums  were  perfectly 
healthy  ;  there  was  almost  no  difference  to  be 
made  out  in  thegirthof  the  two  lower  limbs,  both 
of  which  it  moved  of  its  own  accord.  The  in- 
fant was  now  given  a  mixture  of  cod  liver  oil 
and  iron,  and  a  little  carefully  mashed  potato 
was  added  to  its  diet.  I  have  not  seen  it  since, 
but  on  telephoning  to  the  mother  a  (g\y  days 
ago,  the  child  was  reported  to  be  the  picture  of 
health. 

The  second  case  was  an  infant  aged  11 
months,  the  last  ofa  family  of  six  children,  all 
strong  and  healthy,  and  all  of  whom  had,  as  the 
mother  told  me  at  the  time,  been  brought  up 
on  the  bottle  and  thriven  on  it,  giving  little  or 
no  trouble.  This  one  had  been  perfectly  well 
u|)  to  five  weeks  |)revious  to  my  visit,  when  it 
was  noticed  to  show  signs    of  pain   on  move- 


THE  CANADA  MEDICAL  RECORD. 


205 


nient  of  the  legs.  This,  it  was  thought  by  the 
mother,  would  pa'^s  away,  but  on  its  continu- 
ance, the  family  physician  was  called  in,  who 
examined  the  limb  carefully  and  found  no  sign 
of  any  injury.  Two  weeks  afterwards  the  child 
was  again  seen,  the  diagnosis  of  rheumatism 
made,  and  a  salicylate  mixture  prescribed.  No 
improvement  followed,  the  child  became  very 
restless  atnighl,  and  I  was  asked  by  the  attend- 
ing physician  to  see  the  infant.  I  (oimd  the 
child  veiy  pale,  almost  earthy  in  color,  but 
with  a  fair  amount  of  subcutaneous  fat.  On 
examination,  tiiere  was  evidence  of  slight  ra- 
chitis. Thechest  was  well  shaped,  there  was  no 
ecchymoses  anywhere  to  be  seen,  and  there  was 
no  distinct  enlargement  in  any  place  of  either 
of  the  lower  limbs.  The  child  made  no  effort 
to  move  its  limbs,  and  cried  bitterly  vvhen  any 
forcible  attempt  was  made  to  disturb  them. 
The  reflexes  were  normal.  On  examination 
of  the  mouth,  the  gums  were  found  in  a  very 
similar  condition  to  that  described  as  met  with 
in  the  previous  case.  Around  the  two  lower 
incisors  there  was  a  broad  line  of  inflammation 
of  deep  bluish  hue,  bleeding  easily  when  touch- 
ed. The  lungs,  heart  and  abdominal  organs  all 
appeared  healthy.  On  enquiry,  I  found  that 
while  the  other  children  had  been  fed  on  various 
mixtures  of  milk  and  flour,  for  this  ch:ld  the 
mother  had  been  instructed  to  boil  all  the  milk 
given.  This  she  had  endeavored  to  do  thor- 
oughly, the  better  to  kill  the  germs.  So  the 
boiling  continued  over  several  minutes. 

In  the  way  of  treatment-  I  prescribed  as 
before,  a  little  orange  juice,  and  the  red  juice  of 
underdone  steak.  I  also  stopped  the  boiling  of 
the  milk.  On  the  following  afternoon  I  received 
word  from  the  mother  that  there  was  already  a 
marked  improvement;  and  when  I  called  after 
a  few  days  I  would  hardly  have  recognized  it 
for  the  same  infant. 

Only  a  few  Weeks  ago,  Dr.  Barlow,  in  the 
Uradshawe  Lecture  before  the  Royal  College  of 
Physicians,  has  very  exhaustively  treated  the 
whole  subject  of  scorbutus  in  infancy.  Dr. 
Gee,  in  1871,  first  drew  attention  to  this  dis- 
ease, and  described  five  cases  under  the  title  of 
osteal  or  periosteal  cachexia.  Not,  however, 
until  1878  were  the  symptoms  of  this  disorder 
asserted  to  be  scorbutic  in  character  by  Dr. 
Cheadle,  and  in  1883  Dr.  Barlow,  in  a  lecture 
before  the  Medico-Chirurgical  Society  of  Lon- 
don, gave  the  first  complete  accoimt  of  its  clini- 
cal history,  etiology,  and  the  morbid  condi- 
tions present  in  the  bone  lesinos,  and  demon- 
strated its  resemblance  to  scurvy  in  the  adult. 
Since  then  numerous  cases  have  been  reported 
in  England.  In  America,  Dr.  Northrup,  at 
the  meeting  of  the  American  Pediatric  Society 
in  1889,  ^^^s  the  first  to  report  cases  of  infantile 
scorbutus,  and  in  his  paper  last  year  before  the 
New  York  Academy  of  Medicine,  a  total  of  106 


reported  cases  were  recorded  as  having  been  ob- 
served in  America. 

The  disorder  generally  makes  its  appearance 
in  infants  between  the  ages  of  nine  and  eighteen 
months.  It  is  said  to  occasionally  occur 'as 
early  as  the  fourth  month.  The  onset  is  usu- 
ally su'lJen.  The  infant  becomes  fretful  ;  dis- 
inclined to  move  ;  its  lower  limbs  are  kept 
drawn  up  and  still,  and  any  forcible  m>jveuient 
of  them  gives  rise  to  continuous  crying.  Later 
on,  should  the  condiii:)ns  giving  rise  to  the 
disorder  continue,  an  obscure  swelling  may 
perhaps  be  noticed  on  one  of  the  lower  limbs, 
usually  on  the  femur  towards  its  lower  end,  or 
on  the  upper  end  of  the  tibia,  and  a  few  days 
later,  a  similar  swelling  may  appear  on  the 
corresponding  limb  of  the  opposite  side.  Gener- 
ally the  swellings  are  not  symmetrical.  The 
skin  over  them  is  pale,  and  there  is  no  local 
heat  or  piting.  The  bulk  of  the  limb  is  in- 
creased, but  there  is  no  fluctuation  ;  on  the 
contrary,  the  swelling  is  ill-defined,  and  is  sug- 
gestive of  thickening  round  the  shafts  of  the 
bones.  The  limbs  are  now  more  or  le^s  par- 
alysed, everted  and  immobile,  but  the  patellar 
and  plantar  reflexes  are  active. 

If  the  disease  progress,  swellings  of  the  same 
character  may  appear  on  other  bones;  on  the 
scapulae,  bones  of  the  arm,  vetebi^e,  etc.,  and 
occasionally,  in  some  cases,  fractures  on  slight 
occasion  may  occur. 

One  of  the  more  fretjuent,  and  someiimts 
the  only  swelling  of  the  kind,  as  Dr.  Barlow 
points  out,  occurs  on  the  upper  orbit,  giving 
rise  to  sudden  proplosis  of  tiie  eye-ball,  with 
pufiiness,  and  in  a  few  days,  slight  ecchymosis  of 
the  upper  lid.  These  swellings  are  due  to 
extravasation  of  blood  under  the  periosteum. 
In  severe  cases,  haemorrhage  may  occur  into 
the  centre  of  the  shaft,  leading  to  extensive 
absorption  of  trabecular  tissue,  and  predis- 
posing to  fracture.  Extravasations  are  also  met 
with  in  the  superficial  and  deep  set  of  muscles, 
but  one  never  meets  clinically  with  the  small 
subcutaneous  haemorrhages  of  purpura.  The 
condition  of  the  gum  is  modified,  as  in  the 
adult,  by  the  presence  or  absence  (jf  teeth.  l( 
the  teeth  be  present  we  have  distinct  sponginess 
of  the  gums,  which  in  some  cases  may  go  on  to 
fleshy  swellings,  even  projecting  from  the  mouih 
and  giving  rise  to  fetor.  When  only  a  few 
teeth  are  present  the  sponginess  is  less  marked  ; 
and  if  there  be  no  teeth,  the  gums  may  a|)pear 
normal,  or  may  present  small  bluish  extravasa- 
tions over  the  sites  of  the  advancing  teeth. 

The  chief  constitutional  symptom  is  the 
anaemia,  due  partly  to  direct  cachexia,  and 
partly  to  loss  of  blood  from  the  extravasations. 
Although  emaciation  may  not  be  marked, 
asthenia  appears  to  be  extreme.  Pyrexia  is 
only  slight  and  often  altogether  absent,  but 
occasionally  an  elevation  of  102°  F.  is  recorded, 


206 


THE   CANADA   MEDICAL   RECORD. 


apparently  due  to  the  pain  and  tension  pro- 
duced by  the  extravasation.  I'he  appetite  is 
generally  fair ;  the  urine  is  scanty.  In  severe 
cases,  haematuria  may  sometimes  be  observed. 

The  presence  of  some  degree  of  rachiiii-  was 
noted  by  all  the  earlier  writers  on  this  disease, 
and  some  of  them,  es])ecially  in  Germany, 
attributed  the  morbid  conditions  noticed  to  an 
acute  form  of  rickets.  More  careful  observa- 
tion, however,  showed  that,  while  the  symptoms 
of  both  disorders  might  be  ])resent  in  an  infant, 
tlu-y  were  distinct  and  not  dc|)endent  upon  one 
another.  The  all-irnporiant  factor  in  the 
development  of  scorbutus  in  the  infant,  as  in 
the  adult,  is  a  faulty  dietary.  We  shall  always 
find  in  scorbutic  infants  a  history  of  the  child 
having  been  fed  for  several  months  on  food  of 
which  the  v  talily  has  been  more  or  less  killtd 
by  cooking.  Infants  fed  on  the  so-called 
) latent  foods  for  any  length  of  lime  appear 
especially  liable  to  this  disorder.  'l"o  such 
foods  we  must  also  a  Id  condensed  milk,  milk 
t«.o  long  sterilized,  and  boiled  milk.  As  Dr. 
Barlow  says,  "The  further  we  get  from  living 
food  the  more  is  the  likelihood  of  scurvy  being 
induced."  Scorbutus  does  not  appear  to  be  a 
disease  frequently  met  with  among  the  poor, 
or  in  out-patient  hosj)ital  practice,  for  the  fol- 
lowing rua  ons  given  by  Dr.  Barlow  :  (i)  Such 
patients  are  generally  too  poor  to  afford  the 
expense  of  feeding  their  infants  altogether  on 
paient  foods  \  i.nd  (2)  the  children  of  the  poor 
are  usually  bro  ght  to  the  table  at  an  early  age, 
and  are  given  pieces  from  their  parents'  dishes, 
and  thus  obtain  a  variety,  harmful  in  some  re- 
spects, but  beneficial  in  that  it  prevents  the 
development  of  scorbutic  symptoms. 

It  is  to  be  noted  that  the  symptoms  of  this 
disease  vary  much,  and  are  sometimes  very  apt 
to  mislead.  In  some  cases  irritability  of  the 
infant  and  apparent  tenderness  of  the  limb  are 
out  of  all  projjortion  to  the  signs  found.  In  a 
few  cases  proptosis  due  to  orbital  hemorrhage 
has  been  for  some  days  the  one  prominent 
symptom,  and  if  we  are  not  on  guard,  may  give 
rise  to  a  diagnosis  of  more  serious  disease.  In 
a  recent  lecture  Mr.  Howard  Marsh  calls  atten- 
tion to  several  cases  where  scorbutic  extravasa- 
tions had  led  to  the  diagnosis  in  one  case  of 
sarcoma,  in  another  of  fiaciure  of  the  femur, 
and  in  a  third  of  infantile  paralysis,  the  alarm- 
ing symptoms  cpiickly  subsiding  on  jjroper  diet- 
ary and  treatment. 

There  is  another  'bought  to  bear  in  mind  in 
reference  to  this  disease,  and  it  appears  to  me 
a  most  important  one,  and  it  is  this  :  just  as  we 
may  meet  in  some  children  with  symptoms  of 
rickets  so  slight  that  they  might  easily  escape 
our  notice,  unless  a  careful  consideration  of  tlie 
history  and  examination  of  the  infant  be  made  ; 
and  just  as  such  a  rachitic  condition  may 
underlie  other  disorders  of  the  respiratory  or 
alimentary  tract,  and  require  proper  treatir.ent 


before  these  disorders  can  be  permanently  and 
satisfactorily  cured;  so  may  we  not  have  a 
scorbutic  condition  with  such  slight  syinptoms 
as  to  scarcely  permit  an  absolute  diagnosis, 
yet  may  not  such  a  .disordering  of  nutrition 
underlie  many  troublesome  and  perristcnt  clini- 
cal conditions,  and  require  careful  consideration 
and  treatment  before  we  can  satisfactorily  alle- 
viate the  associated  ailments? 

Dr.  McCoNNELL,  after  reading  the  articles 
referred  to  l)y  Dr.  Blackader,  remembered 
about  two  years  ago  having  had  a  case,  which 
at  the  time  he  diagnosed  a-;  rheumatism,  but 
which  he  now  believes  to  iiave  been  scurvy. 

Dr.  Kenneth  C.'^meron  thought  he  could 
add  another  case  10  Dr.  Blackader's  series. 
The  one  referred  to,  whii  h  occuired  last  sum- 
mer, was  a  child  six  months  old,  fed  entirely 
upon  sterilized  milk  and  Neslle's  food.  It  devel- 
oped subcutaneous  abscesses  all  over  the  body. 
No  teeth  were  present  ;  and  the  gums  were  not 
at  all  inflamed.  Still,  there  was  some  stiffness 
and  pain  in  the  joints,  causing  flexure  of  the 
limbs,  and  this,  together  with  the  eruption  of 
the  skin,  was  all  on  which  he  had  to  form  a 
diagnosis.  As  at  that  time  he  was  making  in- 
vestigations in  connection  with  the  bacillus 
pyocyaneus,  he  suspected  the  patient's  condi- 
tion to  be  of  that  nature.  Bacteriological 
examinatio  1,  however,  proved  negative.  He 
decided  to  treat  it  as  a  scurvy,  and  prescribed 
orange  juice  and  fresh  milk.  The  result  was 
marvellous.  Inside  of  a  week  the  abscesses 
had  healed  up  and  no  others  formed,  the  child 
gave  evidence  of  returning  health  in  every  way, 
and  is  now  perfectly  well.  The  effect  of  treat- 
ment seemed  to  confirm  the  belief  that  the  case 
was  one  of  scurvy. 

Dr.  Morrow  saw  a  case  about  six  months 
ago,  which  he  diagnosed  and  treated  as  scurvy. 
It  suffered  from  sore  mouth,  plai'.ttive  cry,  and 
the  swollen  gums  protruded  into  the  mouth  ; 
there  were  one  or  two  reddish  spots  on  the 
body,  and  restlessness  was  particularly  marked. 
He  prescribed  orange  juice  and  beef  juice,  and 
in  a  week  the  child  was  apparently  well.  The 
jjarents,  it  seemed,  had  been  accustomed  to 
dilute' the  milk  very  much.  It  had  never  had 
anything  but  milk  and  a  little  porridge,  although 
nineteen  months  old. 

Dr.  Orr  h.ad  seen  a  case  that  day  which  he 
suspected  to  be  scurvy.  The  gums  were  much 
swollen  and  bled  readily.  He  examined  the 
child  for  ecchymoses,  but  without  success, 
although  it  appeared  very  sore  all  over.  He 
was  usmg  anti-scorbutic  treatment,  and  would 
await  the  lesult  with  interest.  These  facts  in 
connection  with  scurvy  in  children  so  'lately 
brought  to  light  added,  in  Dr.  Orr's  opinion, 
aiKnher  to  the  already  formidable  difficulties  of 
infant  feeding.  He  would  like  to  ask  Dr. 
Blackader  whether  the  use  of  sterilized  milk 
was  to  be  discouraged  altogether,  and  whether 


THE   CANADA   MEDICAL    R  ECORD. 


207 


we  ought  to  advise  parents  to  add  some  vege- 
table substance  ajid  meat  juice  to  the  diet  as  a 
prophylactic. 

Dr.  Blackadrr  said  in  reference  10  th  •  u^e 
of  patent  infant  foods,  that  one  was  obliged  to 
confess  that  in  some  instances  it  seemed 
necessary  to  have  recourse  to  them.  They 
might  be  used  as  a  bridgj  to  carry  us  over  a 
difficulty,  but  their  proli)nged  use  had  always 
appeared  to  him  objectionable.  The  one  im- 
portant advantage  which  they  possessed  is  that 
tlieir  process  of  manufacture  might  be  supposed 
to  render  them  sterile,  and  during  the  summer 
months,  and  often  during  the  winter  months, 
it  might  be  almost  impossible  in  some  fam 
ilies  to  command  an  absolutely  sterile  food 
in  any  other  way.  In  the  light  shown  by  the 
occasional  appearance  of  scurvy  in  infants  fed 
entirely  on  tliem,  he  thought  we  must  regard 
all  foods  which  had  been  prepared  at  the  tem- 
perature of  about  212''  F.  as  dead  foods — foods 
which  fail  to  afford  a  perfect  nutrition  to  the 
infant. 


lro(\rcss    ot    Scifuce. 


APOCYNUMCANNABINUM  AS  A  CAR- 
DIOKINETIC  AND   DIURKTIC. 

Th.e  drug  has  been  known  for  some  years  in 
America  as  an  emetic  and  cathartic,  and  has 
also  been  employed  to  some  extent  as  a  rem- 
edy against  dropsy.  Examined  by  Schmiede- 
berg  in  1883,  it  was  found  to  contain  an 
amorphous  substance,  apocynin,  and  a  gluco- 
side,  apocyneine,  the  first  soluble  in  alcohol, 
not  in  water,  the  second  easily  soluble  in  water. 
The  physiological  action  of  a  ten-])er-cent.  Tinc- 
ture has  been  investigated  independently  by 
Brandford  and  Murray,  who  considered  its 
effects  as  somewhat  similar  to  those  of  stro- 
phanthus.  The  latter  found  that  it  reduced  the 
frequency  of  the  rapid  heart,  strengthened  its 
beats,  relieved  cyanosis,  and  acted  as  a  good 
diuretic.  Petteruti  and  Somma  {II  Policlinico, 
Nos.  10  to  14,  May  to  July,  1894)  have  used 
the  root  in  two  forms, — an  infusion  with  water 
and  a  tincture.  The  decoction  had  a  strength 
of  I  10  3  in  150,  that  of  the  tincture  being  i  in 
10.  The  results  obtained  in  the  two  cases 
were  as  follows  :  The  action  of  the  decoction 
is  exercised  chiefly  on  the  stomach  and  in- 
testines, promoting  :  first,  catharsis;  and,  se-. 
condly.  emesis.  These  effects  followed,  in  the 
cases  quoted,  the  administration  ofa  decoction 
of  from  I  to  2  grammes  of  the  root  in  150 
grammes  of  water,  divided  into  two  or  three 
doses  in  the  day.  This  emelo-cathartic  action 
is  manifest  either  on  the  first,  second,  or  third 
day.     When  it  is  delayed,  there  are  also  effects 


on  the  urine  and  heart, — namely,  increased 
diuresis,  acceleration  of  the  heartbeat,  and 
arhythmia,  sometimes  also  a  strengtnening  of 
the  heart's  action.  Under  these  conditions 
the  authors  have  observed  diminution  and  final 
disappearance  of  oedema  and  relief  of  dyspnoea. 
This  decoction  is  not,  therefore,  the  best  form 
to  use  in  the  case  of  uncompensated  valvular 
lesions,  on  recount  of  the  emeto-cathartic 
action,  which  is  only  exceptionally  absent. 
The  tincture  was  free  fiom  gastro-intesiinal 
irritant  effects,  even  when  large  doses  were 
employed.  These  effects,  therefore,  are  |)rol>- 
ably  due  to  some  substance  which  is  soluble  in 
boiling  water  but  insoluble  in  alcohol.  On 
tie  other  hand,  marked  cardio-kineiic  effects 
were  obtained  from  the  tincture  when  employed 
■in  doses  of  60  to  90  minims  daily.  It  is 
probable,  therefore,  that  the  effects  of  ihe  de- 
coction are  due  to  the  presence  of  apocyneine, 
those  of  the  tincture  to  that  of  apocynm 
(Schmiedtberg).  A  marked  effect  of  the  tinc- 
ture is  the  production  of  diuresis,  which  is  never 
accompanied  with  albuminuria;  in  fact,  when 
albumin  has  been  present,  it  has  disappeared 
after  a  course  of  the  tincture.  Apocynum 
acts,  therefore,  as  a  diuretic  without  irritating 
the  renal  ei)ilhelium,  by  virtue  of  its  action  on 
the  circulation.  Sphygmographic  tracings  show 
also  a  considerable  increase  in  the  force  of  the 
pulse,  the  rapidity  of  which  is  sometimes 
markedly  diminished.  Change  in  rapidity  is 
not,  however,  a  constant  effect,  and  sometimes 
the  slowing  is  accompanied  by  irregularuy  in 
the  rhythm,  due,  in  all  probability,  to  a  stimu- 
lation of  the  cardiac  branches  of  the  vagus. 
Finally,  apocynum  appears  to  increase  the 
arterial  tension,  but  not  constantly.  On  the 
whole,  therefore,  the  tincture  of  apocynum  is 
likely  to  prove  useful  in  cases  of  imperfect 
compensation  of  valvular  lesions,  either  reducing 
or  even  completely  curing  the  oedema  and 
dyspnoea  which  are  the  indications  ofsucha 
condition.  It  has  the  advantage  over  the  other 
cardiac  drugs  that  it  does  not  irritate  the  pri- 
n.te  vife,  and  that  it  may  be  used  without 
danger  for  a  long  time. — British  Medical 
Journal,  September  22,  1894. 


NEW  METHOD  OF  STERILIZING  LIGA- 
TURES. 

M.  Perier  called  attention  to  a  new  proce- 
dure for  sterilizing  and  preserving  ligatures  and 
sutures,  invented  by  ^I,  Repin.  This  author, 
from  numerous  experiments,  found  that  alco- 
holic vapor  exercises  a  microbicide  action 
sufficiently  strong  to  remove  any  kind  of 
micro-organism  from  ligatures,  'ihe  most 
resistant  spores  such  as  the  bacillus  subtilis, 
anthrax,  tetanus,  and  the  septic  vibrion,  were 
killed  in  from    thirty-five    to  forty-five  minutes 


208 


THE   CANADA   MEDICAL   RECORD, 


by  anhydrous  alcohol-vapor  heated  in  1200  C. 
(2480  F.).  Catgut  is  thoroughly  sterilized  by 
this  method  without  losing  any  of  its  properties. 
The  author  places  the  sterilized  catgut  in  a 
culture  bouillon  and  seals  it  in  a  glass  tube, 
keeping  it  for  several  days  in  an  oven.  If 
sterilization  has  not  been  complete,  microbes 
will  have  develoi)ed  in  the  bouillon,  and  the 
culture  will  have  become  cloudy  ;  if,  on  the 
other  hand,  the  liquid  remain  clear,  it  is  a 
material  and  certain  proof  that  the  contents  of 
liie  tube  are  thoroughly  aseptic. — Semaine  Me- 
(licalc,  June  6,  \'6()^,. 

OPERATIVE    TREATMENT     OF     WRY 
NPXK. 

Mikulicz  (^Coit'albl.f-  Chirur.,  No.  i,  1895), 
dissatisfied  with  the  resuits  both  of  subcuia- 
mous  and  open  division  of  the  sterno  mastoid 
in  cases  of  caput  obstipum,  advocates  almost 
total  removal  of  the  contracted  muscle,  the 
posterior  part  of  its  upper  extremity,  where  it 
is  traversed  by  the  spinal  accessory  nerve, 
being  left.  He  has  praclis-.  d  this  operation  in 
17  cases  with  success,  ihe  only  bad  result 
having  been  disfigurement  of  the  neck  caused  by 
the  absence  of  the  muscle.  Examination  of  the 
removed  muscle  in  these  cases  has  convinced 
him  that  wry  neck  is  the  lesult  of  a  chronic 
inflammatory  condition  —  myositis  fibrosa — 
involving  the  whole  of  the  sterno  mastoid.  This 
condition  he  attributes  in  congenital  cases 
raiher  to  compression  of  the  muscle  during  a 
long  and  difficult  labor  than  to  laceration. 
The  so-called  hcemaioma  of  the  sterno  mastoid 
sometimes  observed  in  infants  is  not  due,  he 
ijolJs,  to  effusion  of  blood,  but  to  thickening 
and  induration  of  the  inflamed  muscle.-  British 
Medical  JournaL 

IMPROVED  METHOD  OF  RADICAL 
OPERATION  FOR  CANCER 
OF  THE  BREAST. 

Dr.  Willy  .Meyer  (^Medical  Rcord)  describes 
ihe  following  melhcd  of  operation  : 

A  skin  iiK  ision  embracing  a  liberal  area 
areund  the  nipple,  and  rjnning  across  the  a.xilla 
to  the  point  of  inseriion  of  the  tendon  of  the 
pectoralis  irajor  muscle,  is  made.  A  second 
incision  is  made  at  right  angles  to  the  one  just 
described,  running  to  the  junction  of  the  middle 
and  outer  thirds  of  the  clavicle.  After  the  skin- 
flaps  are  reflected  the  tendons  of  insertion  of 
the  pectoralis  major  and  minor  muscles  are 
divided,  and  these  muscles,  the  axillary,  subcla- 
vicular, and  infraclavicular  fat  and  lymphatics, 
and  the  diseased  breast  are  removed  in  one 
mass.  The  muscles  are  separated  from  their 
points  of  origin,  and  the  new  growth  is  not  cut 
into  during  the  operation.  The  vessels  entei- 
ing  the  pectoralis   major  muscles  are   clamped 


before  they  are  cut.  The  wound  is  sutured  as 
far  as  possible  and  axillary  drainage  is  used. — 
Internationdl  Medic  ill  Magazine 

DEFECTS    IN    SURGICAL    PRACTICE. 

In  an  exceedingly  instructive  article — from 
which  want  of  space  prevents  us  from  quoting 
as  liberally  as  we  would  like  -Prof.  Skene 
{Brooklyn  Med.  Jour..,  Feb.,  1895 j  points  out 
the  most  prominent  defects  in  surgery  as  taught 
and  practised  at  the  present  time.  He  con- 
siders the  lack  of  dexterity  and  accuracy,  which 
leads  to  s'ow  and  consequently  imperfect  opera- 
ting, as  the  most  noticeable  of  these  defects, 
and  stales  that  every  moment  wasted  in  an 
operation  is  a  detriment  to  the  patient  as  well 
as  the  surgeon.  Rapidity  of  operating  is  es- 
pecially necessary  in  order  to  avoid  prolonged 
anaesthesia,  which  is  injurious  and  tends  to  re- 
tard recovery  by  favoring  non-union,  suppura- 
lion  and  hepsis  Time  is  also  precious,  because 
the  longer  the  tissues  are  exj  osed  and  the 
more  they  are  handled,  the  more  slowly  and 
imperfectly  they  heal.  Tissues  exposed  to  the 
air  for  an  hour  or  more  begin  preparation  for 
healing  by  granulation,  and  are  therefore  less 
capable  of  uniting  by  immediate  union.  Since 
the  introduction  of  antiseptic  surgery,  imperfec- 
tions are  apt  to  arise  from  the  endless  detail 
necessary,  which  in  itself  makes,  it  difficult  to 
attain  perfection.  Another  source  of  defec'.s  is 
the  disposition  on  the  part  of  some  surgeons  to 
devise  new  operations  and  to  modify,  in  the 
hoi)e  of  improving  old  ones,  wh.ile  they  are  in 
black  darkr.ess  regarding  how  to  perform  many 
of  the  operations  that  are  known  to  be  quite  effi- 
cient and  well  established  by  the  surgeons  of  the 
past  and  present.  The  endeavor  to  cover 
too  much  ground  is  also  held  responsible  by 
the  author  as  a  cause  of  defects  ;  for  if  one 
endeavors  to  wrestle  with  the  whole  field 
ot  operative  surgery,  he  finds  such  a  number 
and  variety  of  operations  to  do,  that  one  life  is 
not  enough  for  him  to  perfect  himself  in  them 
all.  —  The  Intern.  Jour,  oj  Surgery. 

CLASS  RJO.M  NOTES. 

— Th.e  best  drug  for  Hiccough  of  Enteric 
Fever,  Prof.  Hare  says,  is  musk,  ten  grains, 
given  by  the  rectum. 

— Prof.  Wilson  says  that  an  attack  of  In- 
fluenza is  sometimes  ushered  in  with  an  attack 
of  nausea  and  vomiting. 

— Prof.  Longstreth  says  ihjbest  antidote 
for  the  depression  caused  by  the  Salicy I  Reme- 
dies is  brandy,  but  black  coffee  also  acts  well. 

— Prof.  Hare  says  in  Uterine  Hemorrhage, 
whit'.h  is  due  to  a  congestion  of  the  pelvic 
viscera,  dry  cups  over  tlie  sacrum  often  give 
relief. 


THE   CANADA   MEDICAL   RECORD. 


209 


THE  CANADA  MEDICAL  RECORD 

Published  Monthly. 


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EDITORS  : 

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London 
F.  WAYLAND  CAMPBELL,  M.A.,  M.D.,  L.R.C.P  ,  Londou 

ASSISTANT  EDITOR 
ROLLO  CAMPBELL,  CM.,  M.D. 

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MONTEEAL,  JUNE,  1895. 

THE  CANADIAN  MEDICAL  ASSOCIA- 
TION. 
We  trust  that  our  readers  are  bearing  in 
mind  the  annual  meeting  of  our  National 
Association, to  be  held  at  Kingston,  Ontario,  on 
the  last  Wednesday,  Thursday  and  Friday  of 
August.  Those  who  have  already  attended 
these  meetings,  and  especially  those  who  attend 
them  regularly,  can  testify  to  the  benefit  they 
derive  from  coming  in  personal  contact  with 
their  brethren.  The  average  medicd  practi- 
tioner's life  is  one  of  self  denial,  occasionally 
intermingled  with  actual  hardship,  so  that  he  is 
fairly  entitled  to  a  few  days'  pleasure  every 
year  ;  and  we  can  assure  him  that  there  are 
few  ways  of  spending  a  holiday  from  whici;  he 
can  derive  greater  pleasure  than  by  making  ac- 
quaintances, often  life-long  friendships,  at  these 
annual  meetings.  But  laying  aside  the  ques- 
tion of  pleasure,  we  maintain  that  it  is  a  duty 
which  he  owes  to  himself  as  well  as  to  his 
patients,  to  keep  himself  thoroughly  in  touch 
with  the  advances  which  are  being  made  all 
along  the  line  of  medical  and  surgical  practice, 
and  it  is  the  unanimous  verdict  of  those  who 
attend  these  meetings,  that  one  learns  more 
in  three  days  in  this  way  than  he  could  possi- 
bly do  in  three  months  steady  reading.  We 
are  aware  that  some  will  say  that  it  does  not 
pay,  or  that  they  cannot  afford  to  leave  their 
practice  for  these  few  days  ;  but  the  sooner 
this  illusion  is  dispelled  the  better.  As  a  rule 
we  are  valued  at  our  worth,  and  if  the  man  who 


loses  no  opportunity  of  adding  to  his  stock  of 
knowledge  is  worth  more  than  the  one  who  is 
content  with  what  he  already  knows,  the  pub- 
lic who  employ  him  will  not  be  long  in  finding 
it  out,  and  in  rewarding  him  accordingly. 
The  only  other  objection  that  can  be  raised  is 
by  those  who  reside  a  thousand  miles  away, 
and  who  think  that  such  a  distance  is  a  rea- 
sonable excuse  for  not  attending.  But  with 
our  present  faciHties,  even  this  distance  is  ac- 
complished in  a  little  more  than  a  day  each 
way;  while,  by  taking  a  single  ticket,  and  obtain- 
ing a  certificate  or  receipt  therefor,  the  return 
joL'rney  will  be  granted  for  one-third  of  a  single 
fare.  The  President-elect,  Dr.  William  Bayard, 
is  eighty-one  years  of  age,  and  yet  we  feel  sure 
that  the  thousand  miles  he  will  have  to  travel 
Will  not  deter  him  from  being  present.  The 
President-elect  of  the  American  Medica\ 
Association,  Dr.  Beverly  Cole,  who  is  seventy - 
three  years  of  age,  travelled  over  six  thousand 
miles  to  attend  the  annual  meeting  at  Baltimore 
and  he  informed  us  that  he  had  attended  many 
meetings  before  there  was  any  trans-continental 
railway,  travelling  ^  from  San  Francisco  to 
Panama  and  from  Panama  to  New  York  by 
steamer,  — a  distance  of  twelve  thousand  miles, 
and  occupying  three  months  of  travel.  After 
such  an  example,  surely  more  than  two  hundred 
of  our  six  thousand  practitioners  of  Canada  will 
manage  to  attend  our  meeting  at  Kingston. 

WHAT  DOCTORS  DIE  FROM. 

From  a  recent  article  by  Dr.  Kortright,  in 
the  Brooklyn  Medical  Jo2crnal,  based  upon 
the  mortality  records  of  450  physicians  who  died 
in  New  Vork  and  Brooklyn,  the  average  age  at 
death  was  54  years  and  the  rate  per  thousand 
was  25,  a  mortality  which  is  only  exceeded  by 
saloon  keepers,  butchers,  quarrymen  and  fac- 
tory operators. 

The  mortality  of  clergymen  is  16  and  law- 
yers 20,  so  that  instead  of  being  the  longest 
lived  of  any,  owing  to  their  superior  knowledge 
of  the  laws  of  health,  the  profession  of  a  doctor 
is  almost  the  most  hazardous.  It  also  appears 
that  suicide  is  four  times  greater  than  llie 
general  average  for  males. 

From  consumption,  the  death  rate  was  only 
half  the  average,  which  shows  that  spending 
much  of  their  time  in  the  open  air  enables  them 


2IO 


THE   CANADA   MEDICAL   RECORD. 


to  defy  the  bacilli  to  which  they  are  daily  ex- 
posed. But  their  death  rate  from  typhoid 
was  three  times  the  average.  The  raorlality 
from  diseases  of  the  heart,  arteries  and  kidneys 
grouped  under  the  term  of  arterc-capillary 
fibrosis,  was  35  per  cent,  of  the  whole,  while  the 
general  average  of  males  is  only  25  per  cent. 
This  means  that  doctors  eat  too  much  and 
drink  too  much  of  alcoholic  beverages  and  not 
enough  pure  plain  water;  and  that  they  do 
not  take  enough  exercise.  The  result  is  high- 
colored  urine  loaded  with  urates  instead  of 
urea.  Uric  acid  irritates  the  lining  membrane 
of  the  blood  vessels  as  well  as  the  tubules  of 
the  kidneys,  while  want  of  exercise  and  fresh 
air  causes  degeneration  of  all  the  muscular 
structures  and  the  deposit  of  fat  in  and  upon 
them.  As  our  contemporary,  the  yi^/^r;?^/^?/ 
the  Atnerican  Medical  Association,  says  :  "  It  is 
the  irregularities  of  living  which  make  the  phy- 
sician neglect  many  hygienic  rules  that  he  for- 
cibly impresses  upon  bis  patients.  He  is  often 
eloquent  in  his  arguments  and  reasons  for  rest 
and  change  and  regular  hours  of  sleep,  to  those 
who  consult  him.  But  alas  !  he  does  not  put 
into  practice  in  his  own  case  what  he  so 
urgently  impresses  upon  others." 

We  have  been  especially  impressed  with  the 
truth  of  these  words  when  we  have  been  the 
guest  at  the  homes  of  distinguished  physicians. 
Not  only  are. they  irregular  in  taking  their  own 
meals,  but  very  often  we  have  known  their 
wives  and  children  waiting  until  three  or  four 
o'clock  for  their  midday  meal,  while  the  doctor 
was  seeing  a  waiting-room  full  of  patients  who 
could  just  as  well  have  been  seen  a  quarter  of 
an  hour  or  twenty  minutes  later.  Every  doc- 
tor owes  it  to  himself  and  to  his  family  to  eat 
his  three  meals  a  day  exactly  at  the  same  hour 
every  day,  and,  with  a  little  management,  the 
thing  can  be  done.  On  the  rare  occasions  on 
which  he  cannot  get  home  for  his  meal,  let  him 
eat  a  biscuit  and  drink  a  tumbler  of  water  at 
the  patient's  house  at  the  regular  dinner  hour, 
which  will  do  him  more  good  and  less  harm 
than  the  eating  of  a  heavy  dinner  three  hours 
after  the  regular  hour,  and  only  two  hours  be- 
fore the  next  regular  meal,  Wc  have  tried 
both  plans,  and  know  whereof  we  speak. 
In  the  same  way  about  sleep.  Many  of  the 
night  visits  doctors  make  after  10  p.  m.  could 
have  been  made  far  better  during  the  previous 


day.  Patients  can  be  easily  taught  to  call  the 
doctor  twelve  hours  sooner,  and  there  is  no 
better  way  of  teaching  them  than  by  a  rigorous 
exaction  of  a  double  fee  for  visits  after  10  p.  m. 
Let  every  doctor  go  to  bed  at  10  o'clock,  and 
if  he  is  called  at  3  or  4  in  the  morning,  he  has 
already  had  a  fair  night's  sleep,  while  if  he  is 
not  called,  he  can  get  up  at  the  regular  hours 
of  6  in  summer  and  7  in  winter.  Dr.  Skene 
wrote  his  great  book  on  Gynaecology  and 
Diseases  of  the  Bladder,  between  6  and  8  a.m. 
Working  the  heart  and  brain  at  full  pressure 
until  two  in  the  morning  and  then  having  to 
take  narcotics  to  obtain  a  few  hours  of  exhaust- 
ing sleep  is  the  stupidest  of  stupid  mistakes. 
We  have  known  more  than  one  young  physi- 
cian, with  promise  of  a  great  future  before  him, 
fill  an  early  grave  from  resorting  to  alcohol  and 
coffee  to  stimulate  him  when  he  was  exhausted, 
and  then  having  to  resort  to  narcotics  when  he 
fain  would  sleep.  Noble  and  self-sacrificing 
as  our  profession  is,  it  does  not  call  upon  us  to 
make  any  such  sacrifice  as  this.  It  is  our  first 
duty  to  take  care  of  our  own  lives,  in  order  to 
do  the  greatest  amount  of  good  to  others.  The 
want  of  exercise  is  not  sufficiently  recognized, 
A  doctor  may  feel  exhausted  after  a  hard  day's 
work  sitting  in  his  oflice  chair,  but  he  would 
feel  refreshed  in  body  and  mind  by  a  short 
walk  or  a  ride  on  the  bicycle.  We  shall,  in  a 
future  issue,  point  out  that  fatigue  is  due  to  the 
accumulation  of  partly  burned  materials  in  the 
blood,  and  we  will  show  how  they  can  be  corn- 
pletely  burned  and  eliminated  from  the  system. 
In  the  meantime  we  will  content  ourselves  by 
saying  that  the  doctor  who  never  takes  a  holi- 
day is  surely  pursuinga  penny-wise-and- pound - 
foolish  policy,  as  foolish  as  the  peasant  who 
killed  her  goose  to  get  the  golden  eggs. 

Let,  us  use  our  best  endeavors  to  prolong 
and  render  more  useful  the  life-work  of  phy- 
sicians. 

CORRESPONDENCE. 

LETTER    FROM    BALTIMORE. 

i^Fy  our  own   Correspondent.) 
Editor  Canada  Medical  Record  : — 
Dear  Sir, 
As  there  has  been  very  little  of  gynecology  in 
your  medical  journal  for  some  time  past,  perhaps 
a  few  notes  of  the  impressions  of  a  visit  to  some 
of  the  leading  gynx^cological  centres  of  the  East- 
ern States,  as  well  as  of  the  recent  meeting  of  the 


THE  CANADA  MEDICAL  RECORD. 


211 


American  Gynaecological  Society  at  Baltimore, 
might  interest  your  readers.      Among  the  most 
active  of  the  younger  men  are  Dr.  Baldy  and 
Dr.     Noble  of  Philadelphia,    of   whom  1  had 
heard  so  much  that  I  was  anxious  to  see  them 
operating.     Dr.  Baldy  is  the  principal  surgeon 
of  the  Gynecean    Hospital  situated  on   North 
1 8th  Street^  a  few  doors  north  of  Dr.  Price's  pri- 
vate hospital.     We   had  the  pleasure   of  seeing 
him    remove    an    intra-ulerine     pregnancy,   a 
fibroid   uterus    by   the  abdomen,    and   several 
lesser  plastic  operations.     The  first  was  a  diffi- 
cult one,  large  quantities  of  blood  clots  having 
to  be   scraped    out  of  the   abdomen  and  many 
intestinal  adhesions  requiring  to  be    separated, 
care   being    taken  to  leave    pieces    of  the   sac 
rather   than  to  tear  the  peritoneal  covering  of 
the  intestine.     The  operation  would  have  been 
an    impossibility    without    the    Trendelenberg 
posture,  which    is    invariably    employed    by 
nearly  every  operator  in  the  States.     Dr.  Baldy 
is  a  very  painstaking   operator,    no  particular 
effort  being  made  to  attain    great  speed.     His 
o;;erating   room  has  walls  of  white  tiles  and  a 
Cement  floor,  and  is  furnished  with  every  requi- 
site  for    rendering  everything   aseptic.       Dr. 
Noble   is  another    young   man   of  remarkable 
activity  and  great  ability.  He  is  the  surgeon-in- 
chief  of  the  Kensington    Hospital  for  Women. 
He  also   has  a  fine    operating    room  with    tile 
walls  and  Mosaic  floor,    and  we  may    add  that 
he  is  a  fine  operator,  as  we  had  the  pleasure  of 
seeing  him  do  several  abdominal  hysterectomies 
for  small  fibroids  or  for  diseased  appendages  ;  for 
it  is  the  rule  now  to  remove  the  uterus  in  every 
case  in  which  the  appendages   are    taken  out. 
This  idea  orginated  in  France,  and  we  must  say 
we  felt  shocked  at  first  at  exposing  women  to 
the  risks  of  a  so  much  more   serious  operation 
than  the  removal  of  the  appendages.     But  after 
hearing  the  arguments  in  its  favor,  namely,  that 
the  uterus  is  of  i:o  use  to  a  woman  who  has  no 
ovaries,  and  only  causes  her  trouble  in  the  form 
of  purulent   discharges,     sometimes    haemorr- 
hages,    and    occasionally      retroversion     and 
prolapse,  while,  on  the  oiher  hand,  it  not   only 
does  not  increase  the  danger  of  a  cceliotoray 
to   remove   the  uterus    with   the   appendages, 
but  even  diminishes  its   danger,    because    no 
raw  stumps  are  left  to  infect  the  peritoneum  or 
to  cause  intestinal  adhesions, — our  opinion  has 
been  considerably  modified  in  its  favor.     Dr. 
Montgomery,  of   Philadelphia,    is    one  of  the 
older  and  most  celebrated  gynaecologists,  being 
professor  of  that  subject  in  the  Jefferson  Col- 
lege.      AVe   had  the    pleasure   of  seeing   him 
doing  some  operations,  abdominal  and  plastic, 
at  St.  Joseph's  Hospital,  a  Catholic  institution 
under  the  care  of  the  nuns,  but  where  they  are 
wise  enough  to  have  a  training  school  for  secu- 
lar or  lay  nurses,  who  are  thoroughly  up  to  date. 
These  bright  and  intelligent  young  kidies  were 
dressed  in  a  costume  of  pure  white,  and  looked 


the    picture  of  asepsis.     The  sisters    were  not 
seen  at  all.  The  operating-room  and  everything 
about  it  was  thoroughly  modern  and  up  to  date. 
Philadelphia  seems  to  be  the  hot-bed  of  gynae- 
cology.    Surely  no    other  city  can    boast  of  so 
many  first-class  men.     Not  only  did  it  produce 
the  great  and  good  Goodell,  who  will  never  be 
forgotten,    but  also    Joseph    Price,  a    remark- 
able  man  of  his   kind,    with  the  largest  expe- 
rience of  any  American  operator ;    and  Baer, 
who  invented  the  present  method  of  perform- 
ing hysterectomy,  closing  over  the  anterior  and 
posterior  flaps  of  peritoneum    after  tying  the 
ovarian    and    uterine    arteries,    removing  the 
uterus  and   dropping  the  stump.     Then   there 
are  Montgomery,  and  Baldy,  and   Noble,   and 
Ashcby,    and    Penrose,  who    has     succeeded 
Goodell    as  professor  of  gynaecology  in    the 
University   of    Pennsylvania.     We    must    not 
forget    Philadelphia's    medical   gynaecologists, 
who  have  done  much  good  work,  namely.  Weir, 
Mitchell  and  Massey.     Dr.  Baer    is  a  man  so 
gentle  and  modest  in  spite   of  his  great  reputa- 
tion that  he  is  beloved  by  everyone.    He  is  fond 
of  Canadians,  having  a  head  nurse  and  several 
other  nurses  from  Canada  in  his  private  hospital. 
His   public  service   is  performed  at  the  Poly- 
clinic hospital.     Jacobs  of  Brussels  was  to  have 
removed   pus  tubes    and  uterus  by   the  vagina 
at    Dr.    Baer's    clinic,    but   unfortunately  the 
"  Gascogne  "  steamer,  in  which  he  was  to  arrive, 
was    delayed,    and    so  we    were    denied  the 
pleasure.     But  being  anxious  to  see  this  opera- 
tion  well  performed,   in  order    to  judge  of  its 
merits  for  ourselves,  we  went  over  to  New  York 
where  Jacobs  had  been   invited  by  Dr.   Polk 
to   demonstrate    the    method    at   his    clinic  at 
Bellevue.     Again    we    were    doomed  to  dis- 
appointment in  seeing  Jacobs  operate,  for  the 
steamer   was  still  overdue ;   but  we   were  more 
than  reconipensed  by  seeing  Dr,  Polk  himself 
perform    three   operations    on    the    tubes  and 
ovaries,  or  for  removal  of  the  uterus    by  the 
vaginal  method,  in   the  presence   of  a  distin- 
guished audience,  including  Gaillard  Thomas, 
Wylie  and  Coe  of  New  A'ork,  and  Heurotin  of 
Chicago.     Personally  Dr.   Polk  has  the   most 
charming    and    winning    of    manners  ;    as    a 
speaker,  he  has  a  beautiful,  soft  but  clear  and 
resonant  voice,  he    makes  use  of  the  choicest 
of  English  language,  and  has  a  way  of  express- 
ing   himself    so    clearly    that    his  opinion  is 
almost  irresistible.     In   a   discussion  he   pos- 
sesses wonderful  tact,  completely  demolishing 
the  argument  of  his  opponent,  yet  doing  it  so 
considerately    that    it    is    impossible   for    the 
vanquished   one   to  feel   hurt.     We    were  not 
surprised  to  be  told  that   he  comes  of  a  fine 
old  family,  for  he  seems  to  have  been    born  a 
gentleman.     His  recent  election  to  the  position 
of  President   of  the  American   Gynecological 
Society  shows    how   highly  he  is  esteemed  by 
the  nmety-one   gynsecologists  of  America  who 


212 


THE   CANADA    MEDICAL   RECORD. 


form  that  very  select  body.  Although  we 
could  not  tail  to  be  very  favorably  impressed 
with  Dr.  Polk  as  an  operator,  we  were  disap- 
pointed with  the  vaginal  method  of  removing 
appendages.  We  felt  convinced  that  he  could 
have  done  the  same  operation  in  less  than  half 
the  time  by  the  abdomen.  Jacobs  claims  that 
the  death  rate  is  much  less  by  the  vaginal 
route,  being  less  than  3  per  cent,  in 
more  than  400  operations,  including  removal 
of  fibroids  and  cancerous  uteri.  He  also 
claims  that  there  is  less  shock  and  a  much 
shorter  convalescence,  and  there  is  no  risk  of 
hernia.  But,  on  the  other  hand,  we  think  these 
advantages  are  outweighed  by  the  great  diffi 
culty  of  performing  the  operation,  especially 
when  the  appendages  are  adherent  to  the 
intestines  and  walls  of  the  pelvis.  Besides, 
when  the  appendages  alone  are  removed,  the 
uterus  is  left  retroverted  and  prolapsed,  while 
by  the  abdominal  route  it  can  be  ventrofixed, 
while  adhesions  can  be  separated  with  much 
less  danger.  Dr.  Polk  himself  admitted  that  the 
vaginal  method  was  slower  and  more  difficult, 
but  that  he  felt  that  it  was  his  duty  to  give  it  a 
thorough  trial  before  finally  adopting  or  con- 
demning it.  We  attended  an  enjoyable  evening 
at  the  gynaecological  section  of  the  Academy  of 
Medicine,  where  we  met  Addis  Emmett,  Cleve- 
land, Wylie,  Pryor,  Goelet,  Janvrin,  Coe, 
Bache-Emmett,  Riddle  Goff,Boldt  and  Edebohs 
and  many  other  celebrated  gynaecologists. 
The  paper  of  the  evening  was  by  Dr.  Goelet. 
After  the  scientific  meeting,  we  assembled  in 
the  dining  room,  where  a  tasty  little  supper  was 
awaiting  us.  We  feel  sure  that  this  little  sup- 
per, although  not  to  be  commended  perhaps 
from  an  hygienic  point  of  view,  contributed 
considerably  towards  the  best  interests  of  the 
profession.  We  hope  some  day  to  see  this 
feature  introduced  into  the  meetings  of  the 
Montreal  societies,  and  in  fact  it  might  be  the 
beginning  of  many  a  town  and  village  medical 
society.  After  a  few  pleasant  and  instructive 
days  spent  among  our  New  York  brethren, 
especially  Drs,  Goelet  and  Emil  Heuel,  wc  has- 
tened to  Baltimore  to  attend  the  meeting  of 
the  American  GyUcECological  Society.  We 
had  already  spent  a  week  there  attending  the 
American  Medical  Association,  the  Gynaecolo- 
gical section  of  which  under  Dr.  Franklin  H. 
Martin  of  Chicago  was  far  the  best  attended  of 
any.  Hysterectomy  was  the  keynote  of  the 
meeting.  Hysterectomy  for  fibroids  ;  hyster- 
ectomy for  pus  tubes  ;  hysterectomy  for  pro- 
lapsus ;  hysterectomy  for  puerperal  septicemia. 
There  were  a  few  odd  papers  on  electricity  for 
fibroids,  electricity  for  intra-uterine  foelation, 
curetting  for  puerperal  fever,  and  ventrofixation 
for  prolapsus.  But  the  greatest  treat  of  the 
meeting  was  witnessing  tlie  oi)erations  of  Dr. 
Howard  Kelly  of  thcjohns  Hopkins  Hospital. 
Though   not  more  than  36  or  38  years  of  ago, 


Dr.    Kelly    is    one    of  the  most   distinguished 
surgeons  of  the  world.     Even  Senn  of  Chicago, 
who  is  conceded   to  be  the  greatest  living  sur- 
geon,  said   to   the  writer  after  witnessing  his 
operations  :  "  Kelly  is  a  genius,  and  we  can  all 
learn    from  him."     On  asking  Senn   what   he 
thought   was   the  secret  of  Kelly's  success,  he 
replied  : ''  The  same  that  gave  the  world  the  one 
and  only  Michael    Angelo.      There  has  been 
only  one  Michael  Angelo,  and  there  has  never 
been  but  one  Kelly."     This    was  a  great  deal, 
coming  from  so  great  a  man    as  Senn.     Nor 
did  we  ever  admire  the  great  Chicago  surgeon 
so  much  as  when  we  heard  him  thus  so  genei- 
ously   complimenting   his  young  Eastern  rival. 
The    audience  before    which  Kelly    performed 
three  or  four  major  operations  within  one  hour 
was  no  ordinary    one.     On  one  side   of  us    sat 
Senn,    Fenger.    and  Martin    of  Chicago,    and 
Marcey  of  Boston  ;  on  the   other,   McLean    of 
Detroit,  Frederick  of  Buffalo,  and  Colley,  Gib- 
ney,  Wyeth,   Gerster,  Sayre,  Otis,  Goelet  and 
Manly  of  New  York.     There  were  also  Beverly 
Cole  and    McMonigal  of  San  Francisco,  Wills 
of  Los    Angeles,  and  Holmes    of    Portland  ; 
Woolsey  of  California  ;  James    B.     Hamilton, 
Surgeon-General  of  the    United   States  Army  ; 
Duff  of  Pittsburg  ;  Deaver,  Price  and  Alder  of 
Philadelphia;  and  EodmanofSt.  Louis,  besides 
more  than  a  hundred  other  well  known  names. 
We  were   all  astounded  by   Kelly's   wonderful 
technical  skill  ;in  less  than  one  minute  a  large 
fibroid  uterus    was  lying  on  the  patient's  abdo- 
men, and  in  two  and  a  half  minutes  more  it  was 
being  carried  away  in  a  dish.     In  less  than  ten 
minutes  all  arteries  were  tied  and  the  perito- 
neum was  closed   over   the    stump,  and   the 
patient  was  wheeled  away  to  have  the  abdomen 
closed  by  an  assistant  in  an   adjoining  room, 
and  another  important  case  was  being  brought 
in.     Kelly    has  four  of  the    best  trained  assist- 
ants living  to-day.    Each  one  of  them  has  him- 
self done  the  operations  in  which  they  assist  their 
master,  so  that  five  men  are  all   working  hard 
at  once.    There  is  no  need  to  ask  for  anything  ; 
the  assistant  knows  what  kind  of  ligature  and 
needle  will   be  required,   and  at  what  moment 
it   will  be   needed.     Instead   of  handing   the 
operator  a  ligature,  the  assistant  places  it  on 
the  artery  and  the    operator  ties  it.     One  man 
cleans   the    si)onges,  which  are    all  on  forceps 
holders,    and  another  man   sponges,  a    third 
holds  the  abdominal  incision  open  with  retrac- 
tors, and  a  fourth   attends  to  the  ligatures  and 
instruments.  The  patient  is  in  the  exaggerated 
Trendelenburg  posture,  so  that  the  bowels  are 
never  seen;  on   the  contrary,  there  is  a   great 
vacant  space  left  after  the   tumor  is  removed, 
where  the  minutest  blood  vessel  and  even  the 
ureters  can  be  plainly  seen.     For  it  is  one  of 
Kelly's  cleverest  tactics  to  waste  no  time  tying 
arteries  until  he  has  the  tumor  out.     Three  of 
the  four  arteries  are  clamped,  only  the  right 


THE  CANADA  MEDICAL  RECORD. 


213 


ovarian  being  tied  at  first.     Dr.  Kelly  removes 
the  uterus  in  all  cases  in  which  it  is  necessary 
to  remove  the   appendages.     He  has  had  over 
a  hundred  hysterectomies  without  a  death,  and 
his  death  rate  for  all   cceliotomies  (abdominal 
sections)    is  less  than   3    per  cent.     He  uses 
medium  Chinese   silk  for   tying    arteries,    and 
fine  silk  for  sewing  the  peritoneum  both  of  the 
pelvis  and  also  of  the  abdominal  incision,  which 
is  closed  in  three  separate  layers.     First,  the 
peritoneum  is  brought  together  with  a  running 
suture;  then  the  fascia  is  fastened  with  buried 
silver  wire  about  a  quarter  of  an    ii:ch  apart, 
and  then  the  skin  is  sewed  with  silk  worm  gut. 
Several  cases  were  seen  which  had  been  closed 
in  this  way  several  weeks  previously,  and  there 
was  perfect  union,  and  the  buried  silver  wire 
did  not  seem  to  cause  any  inconvenience.     It 
could  barely  be  felt  beneath    the  skin.     This 
method  of  closing  the    abiomen  has  reduced 
the    percentage  of  hernias   to   the    vanishing 
point.     But  it  is    in   his    original    studies  on 
catheterization  of  the  ureters  and  kidneys  that 
Howard  Kelly  has  scored  his  greatest  success. 
With  patient   in    the  knee  chest     position  he 
empties    the  bladder  of  urine  and  fills  it  with 
air  so  that  it  is  like  a  small  balloon.   By  means 
of  his  speculum  and  the  laryngoscopic  mirror 
the  light  of  the  incandescent  lamp  is  thrown  in, 
and  every  part  of  the  bladder  wall  can  be  dis- 
tinctly seen,  even  the  little  spurts  of  urine  or 
pus  or  blood  in  case  of  disease  of  the  kidneys 
is  perceived  escaping  from  the   right   or  left 
ureter,  or  both.     Then    with  due  aseptic  pre- 
cautions he  runs  up  the  ureter  into    the  pelvis 
of  the  kidney  a  catheter  two  feet  long,  with 
which  he  empties  cases  of  pyonephrosir,  and 
then  washes  out  the  pelvis  of  the  kidney.     He 
has    thus    cured    several    cases    of   diseased 
kidney  which   in  form.er  times  would  have  had 
to  have  the  organ  removed,  or  die  of  suppura- 
tion.    He   demonstrated   this   method  for  us 
several  times  with  the  greatest  ease.     He  also 
showed  us  the  walls   of  the   sphigmoid  flexure 
of  the   intestine  with  his  long  rectal  speculum 
over  a  foot  long.     Dr.  Kelly  is  just  completing 
a  work  oh  Gynsecology,  which  will  be  every 
word   original.     It   will  give  his  own  opinions 
founded  on  his  own  experience.     His  revenue 
from  private  practice   is  ssid  to  reach  a  fabu- 
lous amount.     We  were  curious  to  find  out  his 
secret  of  keeping  his  health  in  spite  of  such  a 
tremendous   amount  of  work,  and   to  our  sur- 
prise we  discovered  that   it  was  nothing  more 
nor  less  than   the  bicycle.     Twice  a  week   he 
devotes  the  whole  afternoon  to  a  long  ride  out 
in  the    country.     One    would  think  that    his 
time  would  be  so  precious  that  he  could   not 
spare  any  time  for  the  care  of  his  health.     But 
in    this    again    he    shows  his    great  wisdom. 
Without  those  few  hours  of  muscular  exercise 
and  deep    breathing  his  strength  would  break 
down  and  his  brain  give  out ;  but  with  it    we 


find  him  fresh  and  full  of  energy  after  two  or 
three  big  operations:  and  he  told  us  that  he 
rarely  felt  tired.  He  keeps  himself  in  fine 
physical  condition.  If  we  had  learned  nothing 
else,  that  alone  was  worth  the  trip  to  Balti- 
more. He  has  two  secretaries,  and  he  devotes 
two  mornings  a  week  to  dictating  to  them, 
tvyo  other  mornings  a  week  at  the  Johns  Hop- 
kins, and  two  other  mornings  at  his  private 
hospital  and  ofiice.  The  world  has  heard 
something  of  Howard  Kelly  already,  but 
unless  we  are  mistaken  we  will  hear  a  great 
deal  more  of  him  yet,  if  his  life  is  spared. 
There  is  much  more  that  we  would  like  to 
mention,  but  our  letter  has  already  reached 
considerable  proportions  so  we  will  close, 
reserving  the  rest  for  another  communication. 
Yours  truly, 

A.  LAPTHORN  SMITH. 


THE  MEDICAL  COUNCIL. 

The  newly-elected  Ontario  Medical  Council 
meets  to-day,  and  very  general  interest  is  felt 
as  to  what  may  be  the  results  of  the  session. 
As  compared  with  that  of  its  predecessor,  the 
personnel  of  the  appointed  and  homoeopathic 
contingents  remains  practically  unchanged, 
while  that  of  its  elected  element  is  transformed 
— only  four  of  the  former  meinbers  having 
secured  re-election.  The  thirteen  new  men, 
and  at  least  two  of  those  re-elected,  are  pledged 
to  favor  very  important  and  organic  reforms, 
especially  in  the  direction  of  retrenchment,  the 
restriction  of  the  council  privileges  at  present 
held  by  the  universities  and  medical  schools, 
and  the  elevation  of  the  council's  standards  of 
educatioral  requirements  for  matriculation  and 
graduation.  As  fourteen  of  the  thirty-one 
persons  who  compose  the  council  are  quite 
irresponsible  to  the  profession — b.ing  beyond  its 
reach  through  any  available  or  effective  chan- 
nel of  control — those  striving  for  projected 
reforms  may  find  them  unattainable.  If,  how- 
ever, they  can  show  that  the  measures  they 
propose  are  reasonable  and  just,  that  they  are 
clearly  devised  in  the  interests  of  the  profes- 
sion, and  that  they  are  calculated  to  prom-'te 
the  safety  and  well-being  of  the  public,  it  is 
scarcely  conceivable  that  any  of  the  elected 
members  will  be  unwise  enough  to  oppose 
them,  and  thus  fly  in  the  face  of  their  consti- 
tuents. Such  measures  may  also  be  expected 
to  win  the  support  of  the  homoeopaths  in  the 
council,  vvho  are  more  or  less  committed  in 
favor  of  economy  and  educational  advance- 
ment. 

Strange  to  say,  the  university  and  school 
appointees,  who  until  quire  lately  have  been 
generally  regarded  as  the  special  advocates  of 
more  advanced  educational  standards,  have  in 
the  Medical  Council  invariably  cast  their  influ- 


214 


THE   CANADA   MEDICAL   RECORD. 


ence  in  the  opposite  scale.  It  is  witli  this 
educational  aspect  of  the  dispute  between  pro- 
fession and  schools  that  the  public  is  chiefly 
concerned.  It  is  not  well,  in  the  interests  of 
the  public,  that  professions  like  medicine  and 
law,  who^e  members  necessarily  have  them- 
selves to  determine  the  nature  and  extent  of 
the  services  they  shall  render  to  the  sick  or  to 
the  litigious,  should  be  permitted  to  become 
greatly  over-crowded.  In  this  respect,  the 
highest  point  compatible  with  the  safety  and 
well-being  of  the  community  has,  in  the  medi- 
cal profession,  long  since  been  reached  and 
passed.  The  |  rovince  is  over-stocked  with 
doctors,  and  would  fain  see  the  future  annual 
output  improved  in  quality,  and  very  largely 
lessened  in  quantity.  We  look  to  the  council  at 
its  present  session  to  perfect  measures  that  shall 
secure  this  end.  If  it  does  not  do  so,  the  pro- 
fession itself,  or  the  Defence  Association, 
which  has  already  inaugurated  and  secured 
many  useful  reforms,  must  take  the  initiative, 
and  in  doing  so  may  rest  assured  that  the 
movement  will  command  the  approval  of  the 
jiublic  and  the  support  of  the  Legislature. — 
Toronto  Mail,   1 2 1  h  J  u  n  e,  1895. 


BOOK  NOTICES. 

Medical    Gyn.^jcology.       A   treatise   on  th? 
Diseases  of  Women,  from  the  standpoint 
of  the  physician.   By  Alex.    J.  C.  Skeene, 
M.D.,    Professor  of     Gynecology  in    the 
Long  Island  College  Hospital,  New  York, 
formerly  Professor  of  Gynaecology  in  the 
New  York  Post-Graduate  Medical  School  ; 
Gynaecologist  to  the  Long  Island  College 
Hospital;  Ex-President   of  the  American 
Gynaecological  Society,  etc.  ;  with  illustra- 
tions.    i\ew    York,   D.  Appleton   &  Co., 
1885.     Price  $5.00. 
The  author  says  that  the  growth  of  gynaeco- 
logy in   recent   times    has    been    phenomenal, 
especially  in  the  direction  of  surgery,  and  that 
in  this  respect  its  progress  should  have  been 
remarkable  is  not    surprising  in    view  of   the 
great  advance  made  in  general  surgical  know- 
ledge during  that  period.     It  appears  in  medi- 
cal literature  that  surgery  has  been  more  assi- 
duously   cultivated  ll:an  medicine.     This  may 
have  induced  some  to  push  ihe  surgical  treat- 
ment of  diseases  of  women  to  extremes,  and,  in 
fact,  internal  medicine.     On    the  other    hand, 
physicians    who  have   been  over-confident    in 
their  art  may    have  failed    occasionally  to  do 
surgery  full  justice.     This  is  evidently  rcsjjon- 
siblc  for  the  frequent  and  often    illogical  dis- 
cussions which  have  been  going  on  in  the  past 
few  years    regarding    the   so  called  radical  and 
conservative     i)ractice  in    gyuc'ecology.       The 
science   and    art   of   medicine   and  surgery  in 
their  highest  development  should  be  above  all 


party  questions,  and  those  who  place  a  just 
estimate  on  both  branches  of  the  healing  art, 
and  employ  them  without  predilection  and  pre- 
judice, are  the  most  successful  and  reliable. 
Unreasonable  devotion  to  either  medicine  or 
surgery  is  wrong.  The  confciousness  on  the 
part  of  the  author  of  this  status  of  Gynaecology 
is  responsible  for  the  inception  and  genesis  of 
this  work.  How  far  he  may  be  right  in  thinking 
that  there  is  room  for  a  new  work  on  the 
medical  branch  of  gynaecology,  and  to  what 
extent  the  requirements  have  been  met  in  this 
volume,  the  members  of  the  medical  profession 
alone  can  decide. 

The  volume  is  arranged  in  three  parts  :  Part 
I  deals  with  the  primary  differentiation  of 
sex,  development  and  growth  during  early  life, 
a::d  the  condition  favorable  to  the  evolution  of 
normal  organization,  and  the  attainment  of  a 
health  in  purity.  This  involves  the  discussion 
of  heredity  and  environment,  including  rare  in 
childhood,  menial  and  physical  education  and 
culture,  together  with  the  necessary  additions 
during  the  transition  from  girlhood  to  woman- 
hood. 

Part  II  treats  of  the  characters  of  sex,  the 
adaptation  of  structure  to  function,  the  predis- 
position tu  particular  diseases  and  the  causes 
of  certain  afflictions  peculiar  to  women.  Then 
follow  all  the  functional  and  organic  diseases 
common  to  the  period  of  active  functional  life 
of  woman,  which  commonly  come  under  the 
observation  and  care  of  the  physician. 

Part  III  discusses  the  menopause  of  the 
transition  from  active  functional  life  towards 
advanced  years  ;  and  then  the  diseases  of  the 
latter  period.  The  great  object  in  the  first  part 
of  this  work  is  to  consider  as  fully  as  possible 
the  ways  and  means  of  developing  vigorous 
organizations  and  maintaining  healthy  func- 
tional life.  This  necessitates  attention  to 
hygiene  at  all  periods,  and  all  that  the  term 
implies. 

We  have  taken  the  above  notice  of  the  work 
from  the  author's  preface ;  but  after  having  read 
over  several  chapters  very  carefully,  we  feel 
justified  in  saying  that  the  author  has  more 
than. accomplished  the  object  which  he  had  in 
view.  We  have  heard  already  more  than  one 
practitioner  in  this  city  speak  of  this  work  as 
the  most  valuable  addition  to  our  medical  text- 
books that  has  yet  appeared,  and  we  feel  confi- 
dent that  when  tl.in  book  becomes  more  gener- 
ally known  by,  and  placed  in  possession  of,  the 
general  practitioners  throughout  the  country, 
there  will  not  only  be  many  less  cases  of 
diseases  of  women,  but  also  many  of  those 
cases  which  do  exist  will  be  cured  by  medical 
treatment,  instead  of  being  allowed  to  drift  on 
t9  the  more  advanced  stage  when  nothing 
short  of  surgery  will  afford  relief. 

Little  need  be  said  of  Dr.  Skeene's  vast 
experience  ;  he  is  not  only  one  of  the  fathers  of 


THE  CANADA  MEDICAL  RECORD. 


215 


gynaecology  in  America,  but,  owing  to  the  pro- 
minent positions  which  he  has  occupied  in  tlie 
teaching  facuhies  of  New  York  and  Brooklyn, 
he  has  kept  pace  with  the  great  advances  which 
gynaecology  has  been  making  during  the  last 
ten  years.  We  have  had  the  pleasure  of  seeing 
him  at  his  home  and  at  his  work,  and  can 
testify  to  the  great  esteem  in  which  he  is  held 
as  a  teacher,  by  his  large  class  of  students  and 
young  physicians.  When  one  sees  the  number 
of  patients  he  has  to  attend  in  a  day,  one  wonders 
where  he  finds  the  time  to  accomplish  such  a 
task  as  the  writing  of  this  and  his  other  books. 
It  is  a  lesson  to  younger  men  to  know  that  the 
veteran  author  does  his  writing  between  six  and 
eight  a.m.,  while  younger  men  are  still  asleep. 
In  two  hours  a  day  for  three  hundred  days  in 
the  year  a  vast  amount  of  work  may  be  accom- 
plished. 

This  book  of  Dr.  Skeene's  should  be  in  the 
hands  of  every  family  physician  who  is  called 
upon  to  treat  medical  diseases  of  women  and 
girls,  and  his  purchase  will  amply  repay  him 
for  the  expense  incurred.  It  may  be  obtained 
from  Messrs.  Morang  &  Co.,  of  Toronto,  agents 
for  the  Appletons. 

A  Manual  of    the    Modern    Theory  and 
Technique   of   Surgical    Asepsis.     By 
Carl  Beck,  M.D.,    Visiting  Surgeon  to  St. 
Mark's  Hospital  and  to  the  German    Poli- 
klinik   of  New  York    City,  etc.     With   65 
illustrations  in  the  text,  and    12  full-page 
plates.     Price,  $1.25  nett.     Philadelphia  : 
W.  B.  Saunders,  925  Walnut  street,  1895. 
The    author    says  in     his  preface: — "This 
Manual  of  Surgical   Asepsis,    which    is   based 
upon  the  method   employed   in    my   teaching 
upon  the  treatment  of  wounds  at  the  New  York 
Post  Graduate  School  and  at  St.  Mark's  Hos- 
pital, was  written  in  compliance  with  the  solici- 
tations of  tliose  practitioners  whom  it  has  been 
my  pleasure  to  instruct  at  these  institutions. 

"  As  it  is  only  within  a  comparatively  few  years 
that  bacteriology  has  revolutionized  the  practice 
of  surgery,  it  is  natural  that  even  the  most 
excellent  surgical  text-books  lack  full  and  de- 
tailed descriptions  of  the  theory  and  technique 
of  surgical  asepsis. 

"  While  the  leading  idea  has  been  to  write  a 
practical  book  that  would  in  a  measure  meet  the 
deficiency  of  the  larger  works  on  the  subject, 
yet  theory  could  not  entirely  be  omitted,  inas- 
much as  most  of  the  technique  of  modern 
wound-treatment  is  founded  upon  experiments 
conducted  in  the  laboratory.  But  only  those 
experiments  have  been  accentuated  whose  com- 
prehension is  indispensably  associated  with 
that  of  technique,  and  whose  results  can  be 
corroborated  by  clinical  observation.  Hence 
in  this  treatise  there  has  beeu  followed  a  plan 
somewhat  different  from  that  of  my  eminent 
predecessors,  Schimmelbusch,  Braalz,  and 
Terrier. 


"  Certain  details  which  may  seem  unimportant 
upon  superficial  consideration,  but  the  neglect 
of  which  is  incompatible  with  surgical  success, 
have  been  given  more  prominence  than  is 
ordinarily  accorded  them  in  their  connection 
with  the  subject  of  asepsis — for  instance,  tlie 
descriptions  of  the  technique  of  suturing  and  of 
disinfection,  the  dressings  employed  for  the 
different  regions  of  the  body,  the  maintenance 
of  asepsis  in  private  practice,  etc. 

"  An  important  feature  of  this  book,  or  at  least 
so  regarded  by  the  writer,  is  that  a  stricter  line 
of  demarcation  than  usual  is  drawn  between 
wounds  aseptically  performed  by  surgeons  and 
those  otherwise  inflicted  or  those  dependent 
upon  inflammatory  processes.  In  the  latter 
category  antisepsis  asserts  its  prerogatives,  but 
onl)  as  subordinate  to  asepsis.  As  an  expres- 
sion of  the  position  thus  assumed,  were  written 
the  sections  on  Infected  Wounds,  on  Open- 
wound  Treatment,  and  on  the  Renewal  of 
Dressings. 

"Among  the  antiseptic  drugs,  iodoform  is 
assigned  the  most  prominence,  and  in  regard- 
ing its  extensive  employment  by  the  profession, 
its  advantages  and  disadvantages  are  thorough- 
ly discussed.  The  question  of  tuberculosis, 
that  presents  itself  so  frequently  to  practitioners, 
has  also  been  exhaustively  considered  in  its 
relation  to  asepsis.  An  entire  section  is  devot- 
ed to  anaesthesia,  since,  irrespective  of  its  vital 
importance  in  most  surgical  procedures,  its  in- 
sufficient mastering  is  apt  to  impair  seriously 
the  aseptic  condition  of  the  patient." 

The  author  points  out  the  absolute    necessity 
for  eternal    vigilance,    as   the  price   of  safety, 
and  truly  says  that  if  99  points  of  asepsis  have 
been     observed    and     only    i    forgotten,    the 
result  will  be  the  same  as  if  the  whole  100  had 
been    neglected.     Students,      assistants     and 
onlookers  must  never  for  a  moment  forget  that 
the   success   of  the    operation    may  depend  on 
any  one  of  them.     For  this  reason  all  those  who 
take  an    interest    in    the    progress    of  surgery 
would  do  well  to  study  this  work  before  attend- 
ing an  operation  in  any  capacity. 
A    Guide    to    the    Aseptic  Treatment  of 
Wounds.     By    Dr.   C.      Schimmelbusch, 
Assistant  in  the    Royal  Surgical  Clinic  of 
the  University  of  Berlin.     Preface  by  Prof 
E.  Von  Bergmann.     Translated  from  the 
second    revised     German     edition     with 
express  permission  of  the  author,  by  Frank 
J.  Thornbury,  M.D.,   Lecturer  on  Bacteri- 
ology, University  of  Buffalo,  N.Y.,  Super- 
vising    Microscopist    in    the    Bureau    of 
Animal   Industry,    U.S.    Department    of 
Agriculture  ;  late  Senior  Resident   Physi- 
cian Cincinnati  Hospital,  Cincinnati,  Ohio. 
Wiih  43  illustrations.  G.  P.  Putnam's  Sons. 
The   author   and  the    translator   have  both 
enjoyed    exceptional    facilities    for    becoming 
i  thoroughly    acquainted    with  modern    aseptic 


2l6 


THE   CANADA    MEDICAL   RECORD. 


methods  in  Von  Bergmann's  clinics,  and  we  can 
assure  our  readers  that  the  work  before  us  leaves 
no  questions  unanswered  concerning  asepsis 
upon  which  in  modern  surgery  almost  every- 
thing depends.  The  preparation  of  silk;  catgut, 
instruments  and  dressings  is  fully  described, 
and,  as  Bergmann  says  in  the  preface  that  he 
does  not  have  time  lo  give  these  details  during 
his  clinic,  he  recommends  his  pupils  to  learn 
them  from  this  book  prepared  by  his  assistant. 
We  have  derived  the  greatest  pleasure  in  read- 
ing this  small  book,  and  strongly  recommen  I 
it  to  everyone  who  does  any  surgery  at  all. 
'I'he  mechanical  features,  such  as  fine  paper, 
good  type  and  pretty  binding,  make  the 
volume  very  attractive. 


PUBLISHERS  DEPARTMENT. 

A    WOMAN'S    MIDSUMMER     MAGAZINE. 

The  safeguardb  of  marriage  are  treated  of  by  Dr. 
Parkhurst  in  the  July  Lathes'  Honic  Journal  in  a  way 
that  will  strike  many  as  particularly  direct  and  to  the 
point.  Never,  perhaps,  has  the  marriage  question  been 
so  well  dealt  with.  The  romantic  life  of  the  widow  of 
Octave  Feuillet  is  charmingly  treated  by  Madame  Blanc, 
under  her  pseudonym  of  "  Th.  Bentzon,"  while  Heze- 
kiah  Buiterworth  tells  '-The  Story  of  Brook  Farm," 
that  unique  New  England  experiment  which  is  unknown 
to  a  large  part  of  the  prtsent  generation.  The  illustra- 
tions show  "  Brook  Farm  "  as  it  is  today.  The  mu-i- 
cal  features  of  this  issue  are  many,  the  most  valuable 
probably  being  an  article  on  "  The  Voice  of  Highest 
Range,"  by  Frederic  Peakes,  one  of  the  best  known  au- 
thorities on  voice  culture,  and  Mrs.  Garrett  Webster's 
carefully- prepared  article  on  "The  Pay  of  Women 
Musicians."  Instrumentalists  are  remembered  in  a  set 
of  very  melodious  waltzes  called  the  "  American  Girl 
Waltzes,"  by  Mr.  Richard  Stahl,  the  well-known  com- 
poser. Ella  McKenna  Friend  writes  of  the  home  life 
and  personality  of  Rosa  Bonheur,  the  celebrated  animal  ! 
painter,  and  a  recent  portrait  is  given  of"  The  Recluse  i 
ofFontainebleau."  Caroline  Leslie  Field's  short  story, 
"  Miss  Teele,  of  Gilbury  Green,'*  is  a  delightful  bit  of 
simple  New  England  fiction.  The  editor  discusses 
"  The  Blot  on  Our  American  Life,"  which  he  claims  is 
the  disrespect  shown  everywhere  for  persons  in  authority 
both  in  political  and  civil  life.  Kobert  J.  Burdette  fur- 
nishes an  inimitable  article  entitled  ''  A  Woman  in  a 
Raspberry  Patch,"  and  John  Kencrick  Bangs  is  irresist- 
ibly funny  in  his  report  of  the  eighth  meeting  of  "  The 
Paradise  Club."  Dainty  housekeepers  will  be  charmed 
with  Mrs.  Barnes- Bruce's  '•  A  Violet  Table  Set."  Mrs. 
>fallon"s  illustrated  page  tells  of  "Underwear  for  the 
Summer."  "Amusing  Children  in  Summer"  is  the 
title  of  a  page  devoted  to  outdoor  and  indoor  summer 
parties  for  children,  and  serves  to  add  attractiveness  to 
an  issue  which  goes  out  to  its  hundreds  of  thousands  of 
readers  in  a  dainty  cover  ex(juisitely  illustrated  by  W. 
L.  Taylor.  The  Ladies'  Home  Journal  \<,  published  by 
The  Curtis  Publishing  Company  of  Pliiladelphia,  for 
ten  cents  per  number  and  one  dollar  per  year. 


other  observers  I  have  proved  to  my  satisfactjouits  certain 
value  as  a  promoter  of  parturition,  whether  typical,  de- 
layed or  complicated,  and  its  effectiveness  in  controlling 
the  vomiting  of  pregnancy.  In  cases  marked  by  un- 
usual suffering  in  second  stage,  pains  of  nagging  sort, 
frequent  or  separated  by  prolonged  intervals,  accom- 
panied by  nervo  IS  rigors  and  mental  forebodings,  one  or 
two  doses,  thiee  to  hve  grains  each,  of  antikamnia 
promptly  changes  all  this. 

"  If  there  is  a  'sleepy  uterus,'  antikamnia  and  quin'ne 
awake  every  energy,  muscular  and  nervous,  and  push 
labor  to  an  early  safe  conclusion .  Indeed,  in  any  case 
of  labor  small  doses  are  helpful,  confirming  effons  of 
nature  and  shortening  d'jration  of  process. 

"  I  have  just  finished  treatment  of  an  obstinate  case 
of  vomiting  in  pregnancy.  A  week  ago  the  first  dose 
of  antikamnia  was  given,  nervL.u=;  excitement,  mental 
worry  and  gastric  intolerance  lapidly  yielded.  This 
case  was  a  typical  one,  and  the  result  is  clearly  attiibuta- 
ble  to  the  masteiful  influence  of  your  preparation. 

'•  If  there  is  any  one  drug  or  preparation  that  can  ise 
made  to  answer  every  need  of  the  physician,  for  the  cor- 
rection of  the  multitudinous  disturbances  of  innervation 
that  occur  in  the  various  diseases  iie  is  called  upon  to 
treat,  that  one  is  antikamnia." 


DISTURBANCES  UF  INNERVATION. 

Robert  B.  McCall,  M.D.,  Medical  College  of  Ohio, 
Cincinnati,  now  residing  at  llamersville,  Ohio,  writes: — 

"  My  confidence  in  antikamnia  is  so  well  established 
that   I    have  only    words   of  praise.      Independently    of 


LITERARY  NOTE. 

A  new  botik  on  Canada,  by  Dr.  Bourinot.  will  shortly 
be  issued.  It  is  entitled  "  How  Canada  is  Governed," 
and  gives  in  plain,  simple  language  a  short  account  of 
the  Executive,  Legislative,  Judicial  and  Municipal  Insti- 
tutions of  the  Country,  together  with  a  ske'.ch  of  their 
origin  and  development.  The  book  will  be  illustrated 
with  numerous  engravings  and  autographs,  and  being 
the  work  of  so  eminent  an  authority  as  Dr.  Bourinot, 
will  be  indispensable  to  those  who  wish  to  be  well  in- 
formed about  the  affairs  of  the  Dominion. 

The  Copp,  Clark  Comi'ANY  (Limited)  are  the 
publishers. 


The  weekly  issues  of  Litlell's  Lhing  Age  are 
delightful  companions  at  all  seasons  of  the  year.  The 
reader  can  always  depend  on  them  to  contain  just  the 
right  thing  to  suit  the  present  mood.  There  is  so  much 
variety— the  range  of  subjects  is  so  wide,  as  will  be  seen 
from  the  following  partial  table  of  contents  of  the  July 
number. 

"  Walter  Savage  Landor,"  by  John  Fyvie  ;  "  Italian 
Disunion,"  by  Jos.  Crooklands  ;  "A  Journey  to  Scotland 
in  thD  Year  1435,"  by  J.  J.  Jusserand  ;  "  The  Honre- 
Life  of  the  Verneys,"  by  L.  B.  Lang  ;  "  Napoleon  at  St. 
Helena.  A  Reminiscence  "  ;  ''  International  Law  in  the 
War  between  Japan  and  China,'"  by  'T.  E.  Holland  ; 
"  Englantl  and  France  on  the  Niger.  'The  Race  for 
Borgu,"  by  Captain  F.  1>.  Lugard  ;  "  The  .\fter  Careers 
of  UniversiiyTvlucatcd  Women,"  by  Alice  M.  Gordon; 
*'  Tlie  Poetry  of  Keble,''  by  Arthur  Christopher  Benson; 
"  Advertising  as  a  Trespass  on  the  Public,"  by  Richard- 
son Evans  ;  "  Concerning  Duppies,"  by  Alice  Spinner; 
"  Montaigne's  Adopted  Daughter."  by  F.  J.  Hudleston  ; 
"Napoleon  on  Board  II.  M.  S.  Bellerophon  "  ;  ''  The 
Campaign  of  Flodden,  ''  by  C.  Stein  ;  "  The  Attack  on 
I'lbet,"  by  I>.  Gath  Whitley  ;  ''Of  Cal^bages  and 
Kings  "  •,  "  Isandhlwana,  Zululand,  1S94,  "  by  E.  A. 
Hirst;  "Killed  by  the  B.-illic  Canal,"  by  Poultney 
Bigelow,  besides  several  short  stories  by  the  best  writers, 
and  poetry. 


^ 


f 


ll|tPlf; 


m 


m^ 


4> 


Vol.  XXIII, 


MONTREAL,  JULY,  1895. 


No.  10. 


ORIGINAL  COMMUNICATIONS 

Home  and  Foreign  Climates  in  Cou- 
siimptiou 217 

A  Plea  for  Efficient  Legislation  Re- 
gulating Medical  Practice 21S 


SOCIETY  PROCEEDINGS. 

-Montreal  ^Medico-Cliirurgical  Soci- 
ety  221 

Large  Interstitial  Uterine  Tumor, 
with  Great  Development  of  the 
Uterine  Wall  and  -Moderate  la- 
crease  of  the  Uterine  Cavity 2U 

Cholecystcnterostomy  from  the  Use 

of  Murphy's  Button     221 

Four  Cases  "of  Extra  Uterine  Preg- 

iiRncy..     ". .  222 

Uterine  Fibroid 226 

Dermoid  Cyst  „ ,  22G 

Foreign  Body  in  the  Blad  ler   .    .....  22d 

The  late  Dr.  E.  E.  Duquet 227 

Perforated  Gastric  Ulcer   :;27 


G  o  jsr  t:b  jsr  Ts. 

(Gallstones  229 

A  Case  of  Multiple  Carcinomatous 

Growths  in  a  Cirrhosed  Liver  229 

On  Two  Different  Conditions  of  the 
jMitral  Valve  giving  rise  to  Presys- 
tolic Murmur 230 


PROGRESS  OFSCIElVCE. 

Persistent  Urethral  Disidiarges  due 
to  Seminal  Vesiculitis 232 

The  Treatment  of  Stricture  of   the 
CEsophagus 232 

A  New  Operation  for  the    Radical 
Cure  of  Hernia  233 

A  Xew   Method  of  Shortening  the 
Tendi  1  Ach  illis 233 

Diagnosis  and  Treatment  of  Appen- 
dicitis  233 

The  Neatest  Circumcision 233 

Local    Electrolysis   and   Zinc-Amal-  , 
gam  Cataphoresis  in  Malignant  and 
Non-Malignant  Tumor 231 

Class  Notes —  2J5 


EDITORIAL. 

The  Advantages  of  Private  Hospitals  236 

Canadian  Medical  Association. 236 

The  American    Electro-Tlierapeutio 

Association   238 

Selection 238 

Class-Room  Notes 238 

BOOK  NOTICES. 

The  Care  of  the  Baby 238 

Pocket    Formulary     and     Table    of 
Doses,   and  also  Therapeutics    of 

Children's  Diseases 239 

Le  Moyen- Age  Medical '. 239 

Maladies  Internes  at   Maladies  des 

Enfants 2.39 

La  Mort  Apjiarente  du  Nouveau-N6.  239 
La    Prostitution    dans    I'Antiquite, 
dans  ses  rapports  avec  les  maladies 

veneriennes 259 

La  Cure  de  Barfeges  240 

Pamphlets  received 240 

Publishers'  Department   240 


|ri0fnal    irommuntcations 


HOME  AND    FOREIGN    CLIMATES 
IN  CONSUMPTION.* 

Doctor  Playter  contributed  a  paper  on 
"  Home  and  Foreign  Climates  in  Consump- 
tion," mostly  extracts  from  a  book  on  con- 
sumption now  in  the  printers'  hands,  in 
which  he  contends,  and  quotes  authori- 
ties to  prove,  that,  in  the  present  state 
of  our  want  of  knowledge  of  the 
effects  upon  the  human  functions  of  the 
various  atmospheric  conditions,  change  of 
chmate  is  an  empirical  remedy  having  no 
theoretical  foundation,  and  that  acclima- 
tization is  a  process,  the  possible  injurious 
effects  of  which  will  often  outweigh  any 
benefit  derived.  In  hardly  one  case  in  a 
hundred  is  such  a  change  desirable,  although 
change  of  locality  is  often  essential. 

A  warm  climate  sometimes   gives  more 
comfort  and  prolongs  life  in  advanced  cases  ; 

'I-  Abstract  of  paper  read  before  Ontario  Medical  Association. 


and  occasionally  in  the  early  stage,  a  young 
man  indifferent  about  his  health  may  be 
sent  to  an  elevated  climate. 

Theory  and  practice  have  taught  us  that 
what  the  consumptive  needs,  first,  last  and 
always,  is  more  pure  air,  more  oxygen,  and 
this  in  its  best,  most  invigorating  form. 
This  cannot  be  best  supplied  by  a  warm  nor 
by  a  thin  atmosphere.  The  consumptive, 
whether  from  heredity  or  hab't,  is  an  imper- 
fect breather.  In  the  development  of  the 
soil  for  the  tuberc'e  bacillus  imperfect  res- 
piration plays  the  chief  part  ;  all  other 
causes  are  but  remote  and  conti  ibutive  to 
this  one— an  imperfect  respiratory  function, 
which  clogs  the  entire  organism  with  the 
degree  of  imperfect  tissue  metabolism  from 
want  of  oxygen. 

In  the  decomposition  of  this  accumulat- 
ed effete  matter,  not  only  are  inorganic, 
substances  formed  which  constitute  food 
for  the  bacilli,  but  possibly  also  organic 
toxines,  which  ti'ansform  simple  saprophytic 
bacilli  into  poisonous  or  virulent  pathogenic 
organisms  or  infections,    the    anaWue   of 


2l8 


THE   CANADA   MEDICAL   RECORD. 


which  we  sometimes  have  in  the  transfor- 
mation of  the  bacillus  coli  communis  by  in- 
testinal toxines. 

In  the  rarified  air  of  high  mountains 
with  the  climbing,  there  is  great  and  forced 
expansion  of  the  lung  membrane.  The 
subject  actually  gasps  widely  for  breath 
in  order  to  compensate  for  the  thinness  of 
the  air.  The  whole  function  of  respiration 
is  aroused  and  improved,  and  the  body 
purified  and  invigorated,  but  altitude  is  not 
necessary.  This  function  can  be  more 
readily  improved  at  lower  levels  with  the 
richer  air  of  Canada  by  suitable  lung 
gymnastics,  if  the  patient  will  only  per- 
severe in  the  exercises ;  and  more  safely 
too  in  hemorrhagic  cases,  in  which  there 
is  considerable  risk  in  going  somewhat 
suddenly  to  a  much  elevated  climate. 

Dr.  Playter  refers  to  the  benefits  of  com- 
pressed air,  and  of  the  dense  air  at  sea,  where 
the  mortality  from  consumption  has  been 
shown  to  be  sixteen  times  less  than  on 
land  ;  results  not  attributable  alone  to  the 
purity  of  the  sea  air. 

The  purer  air  of  great  elevations  is  an 
important  condition.  Yet  we  have  in 
many  parts  of  Canada  a  practically  pure 
highly  ozonous  atmosphere  at  all  seasons 
while  over  our  snow -covered  expanses  dur- 
ing several  months  of  the  year  is  air  pro- 
bably as  germless  as  on  sea  or  high  moun- 
tain. The  colder  the  air  breathed,  the  more 
oxygen  it  contains,  and  the  more  too  it 
expands  in  the  air  chambers  on  becoming 
warmed  to  the  lung  temperature.  Con- 
sumptives in  Canada  in  nearly  all  cases 
have  acquired  the  predisposition  by  means 
of  indoor  occupation,  or  a  habit  of  housing 
in  close,  over-heated  rooms,  and  they  may 
be,  the  most  susceptible  of  them,  gradually 
habituated  back  again  to  an  outdoor  life, 
even  in  the  coldest  season,  by  proper 
attention  to  the  skin, — suitable  clothing  and 
especially  the  cool  bath.  The  sudden 
changes  in  temperature  in  Canada,  although 
trying,  are  invigorating  and  often  less  mark- 


ed and  sudden  than  on  high  altitudes.  At 
Davos  the  thermometer  has  shown  a  drop 
of  150°  F.  (from  166°  to  16°)  between  the 
midday  sunshine  and  the  following  night. 
Dr.  Playter  contends  that  we  have  in 
Ontario  and  Quebec  some  of  the  best 
localities  for  consumptives  on  this  planet. 
Muskoka  has  a  reputation  as  a  good  one 
It  is  sufficiently  elevated,  has  a  dry,  pure 
and  invigorating  atmosphere  and  a  large 
proportion  of  sunny  days.  The  ideal  place, 
the  doctor  thinks,  is  on  the  Gatineau  moun- 
tains, a  few  miles  from  Ottawa,  in  about  the 
same  latitude  as  Muskoka.  With  a  pure 
and  highly  bracing  air,  and  a  large  number 
of  sunny  days,  it  has  a  south-eastern 
aspect,  and  protection  on  the  north-west 
by  a  much  more  elevated  wooded  ridge  > 
and  is  hence  suitable  for  all  seasons.  It 
has  a  delightful  outlook,  with  a  view  of 
about  4000  square  miles  of  beautiful 
country, — the  Ottawa,  Rideau  and  Gati- 
neau Rivers,  their  valleys,  windings  and 
waterfalls,  and  the  beautiful  capital  of  the 
Dominion  at  the    meeting  of  three  waters. 

A  PLEA  FOR  EFFICIENT  LEGISLATION 
REGULATING    MEDICAL  PRACTICE. 

By  Perry  H.  Millard,  M.D.,  of  St.  Paul. 

(  Concludea) 

Having  submitted  satisfactory  evidence  of 
preliminary  fitness,  only  such  persons  should 
be  admitted  to  undergo  the  professional  test  as 
have  received  their  courses  of  professional 
education  at  schools  of  medicine  whose  curri- 
cula of  requirements  are  acceptable  to  the  re- 
spective boards.  A  minimum  of  requirements, 
both  as  to  time  and  teaching  facilities,  are  as 
essential  in  measuring  professional  fitness  as  it 
is  for  similar  purposes  in  universities,  colleges, 
and  our  public  school  system.  A  school  should 
not  be  recognized  unless  it  is  working  under  a 
minimum  that  will  assure  the  graduation  of  a 
class  of  persons  that  can  safely  be  entrusted 
with  the  care  of  the  sick.  In  arriving  at  a  con- 
clusion upon  this  most  important  function  I  de- 
sire to  particularly  impress  upon  the  members 
of  these  boards  the  fact  that  medicine  as  at 
present  understood  and  practised  is  radically 
different  from  that  of  a  few  years  ago.  To  com 
prehend  requires  years  of  study  and  a  training  in 
laboratory  methods  and  surgical  technique  that 
can  only  be  grasped  when  afforded  by  a  person 


tHE  CANADA  MEDICAL  RECORD. 


219 


trained  in  methods  of  medical  pedagogy.  The 
clinical  and  laboratory  facilities  of  many  of  our 
schools  are  shamefully  inadequate,  several  col- 
leges known  to  the  writer  having  operated  for 
years  with  substantially  no  assets.  It  is  the 
duty  of  each  board  to  enquire  fully  into  the  faci- 
lities of  each  school  represented  by  graduates 
who  are  applicants  for  degrees. 

Having  determined  upon  tlie  fitness  of  the 
school  to  afford  satisfactory  courses  of  medical 
instruction,  applicants  holding  degrees  from 
such  institutions  should  be  admitted  and  a 
further  test  of  fitness  demanded  by  requiring  an 
examination  upon  all  the  recognized  branches 
of  medicine.  These  examinations  should  be 
conducted  by  number,  be  scientific,  and  of  suf- 
ficient severity  to  assure  the  public  a  thoroughly 
educated  profession.  Students  from  the  re- 
spective schools  of  practice  should  undergo  an 
examination  upon  the  same  questions,  no  ne- 
cessity existing  for  questions  not  primary  in 
character. 

Licenses  should  not  be  refused  or  revoked  for 
other  than  gross  unprofessional  or  dishonorable 
conduct.  In  criminal  cases  it  is  not  well  to 
anticipate  the  processes  of  criminal  law.  The 
latter  feature  of  our  legislation  has  been  instru- 
menial  in  protecting  the  people  from  the  pro- 
fessional charlatan  in  several  states.  Its  pro- 
visions should  be  incorporated  in  all  statutes 
regulating  medical  practice. 

Owing  to  the  difficulty  in  securing  indict- 
ments and  the  consequent  tardiness  of  legal 
processes,  the  penalty  for  violations  of  the  pro- 
visions of  this  form  of  legislation  should  be 
by  penalties  imposed  by  a  justice  or  a  municipal 
judge  ;  the  latter  method  has  given  satisfaction 
as  far  as  I  am  aware.  Reasonable  efficiency 
upon  the  part  of  the  officers  of  these  boards 
have  been  awarded  by  a  full  compliance  with 
the  provisions  of  this  form  of  statute  in  all  in- 
stances. The  Governor  should  have  the  ap- 
pointing power,  being  responsible  for  the 
successful  operations  of  the  different  state 
boards.  Experience  satisfies  us  that  the  so- 
called  mixed  boards  are  doing  satisfactory 
work  and  operating  in  perfect  harmony.  Seem- 
ingly no  excuse  exists  for  the  duplicate 
boards  operating  in  a  very  few  States.  At 
present  approximately  thirty  States  possess 
legislation  regulating  medical  practice.  Seven- 
teen States  have  a  form  of  statute  that  fails  to 
recognize  the  diploma  as  evidence  of  fitness  to 
practice ;  consequently  they  may  be  classed 
with  those  States  operating  under  efficient  acts. 
In  the  latter  class  of  States  I  particularly  desire 
to  call  your  attention  to  the  lesults  of  work  thus 
far  accomplished.  In  a  paper  read  before  this 
learned  body,  at  Detroit,  Michigan,  in  1892,  I 
suggested  the  future  influences  of  these  boards 
as  most  important  in  shaping  the  future  medi- 
cal education  in  this  country.  I  submit  data 
at  this  time    confirmatory  of   the  position  then 


taken,  and  reaffirm  my  former  suggestion  that 
future  legislation  will  in  a  great  measure  deter- 
mine and  govern  the  work  of  the  teaching 
bodies  of  the  country. 

I  am  deeply  indebted  to  the  officers  of  the 
various  boards  for  courtesies  extended,  and 
regret  that  space  forbids  reference  to  many 
suggestions  and  conclusions  arrived  at  in  the 
work  of  the  different  boards. 

Data  have  been  obtained  from  the  following 
named  States  :  Alabama,  Minnesota,  Maryland, 
North  Djkota,  North  Carolina,  New  York, 
New  Jersey,  Virginia,  and  Washington. 

The  subjoined  table  indicates  briefly  the 
work  of  these  boards  : 

State.                 Examined.  Licensed.  Rejected.  Per  cent. 

Alabxma 647  558  89  0.862 

Maryland 150  105  25  0.806 

Minnesota 641  499  142  0.778 

New  York 967  797  170  0.824 

New  Jersey 447  4'7  3°  0-955 

North  Carolina.  615  508  207  0.71 

North  Dakota . .       81  76  5  0.938 

Virginia 835  613  222  0.734 

Washington...,  207  167  40  0.806 

Totals 4670  3740         930         0.822 

It  will  be  observed  that  of  four  thousand  six 
hundred  and  seventy  persons  examined,  but 
eighty-two  and  two-tenth-;  per  cent,  were  suc- 
cessful in  securing  a  license.  The  nine 
hundred  and  thirty  unsuccessful  applicants 
have,  we  doubt  not,  principally  located  in 
States  not  protected  by  this  form  of  legislation. 

I  am  pleased  to  direct  your  attention  to  the 
good  work  of  the  Minnesota  board.  The  first 
act  regulating  medical  practice  in  this  State 
became  operative  in  March,  1883.  It  was  the 
form  of  legislation  at  present  in  force  in  Illi- 
nois. It  was  in  operation  five  years,  being 
supplanted  by  the  present  law.  The  present 
act  requires  an  examination  of  all  persons 
commencing  the  practice  of  medicine,  and,  as 
amended  by  the  last  legislature,  the  minimum 
of  requirements  is  changed,  demanding  that  all 
graduates  of  later  date  than  1898  furnish  sat- 
isfactory evidence  of  having  attended  at  least 
four  courses  of  lectures  in  different  years,  of 
not  less  than  six  months  duration  each. 

We  have  in  Minnesota  a  practical  illustra- 
tion of  the  position  taken  in  my  former  paper : 
"  that  in  medical  legislation  we  have  the  only 
solution  of  the  problem  of  higher  medical  edu- 
cation." Having  drafted  these  bills,  and  by 
force  of  circumstances  been  somewhat  conspi- 
cuously a^^gressive  in  urging  their  enactment, 
I  have,  in  consequence,  witnessed  their  opera- 
tions with  some  concern  and  interest.  The 
result  is  all  that  the  most  sanguine  could 
have  anticipated.  In  a  period  of  twelve  years 
the  proportion  of  physicians  to  the  population 
in  Minnesota  has  been  reduced  from  one 
practitioner  to  every  six  hundred  and  fifty  in 
1883  to   one  to  every  one  thousand  in  1895. 


220 


THE   CANADA   MEDICAL   RECORD, 


The  State  has  been  substantially  rid  of  the  tra- 
velling charlatan.  The  present  able  Secretary, 
Dr.  McDavitt,  informs  me  that  the  Medical 
Census  just  completed  is  accurate,  and  that  the 
present  operation  of  the  law  is  quite  faultless. 
We  therefore  conclude  that  in  one  Slate  at 
least  the  number  of  physicians  have  been 
reduced  to  a  number  commensurate  with  the 
demands  of  the  pcop.e. 

The  work  of  the  New  York  Board  is  attract- 
ing considerab'e  attention.  Notwithstanding 
pronounced  opposition  and  many  embarrass- 
ments, the  act  is  destined  to  strengthen  the 
character  of  the  profession  in  this  State.  From 
advance  sheets  kindly  furnished  for  use  in  this 
paper,  I  observe  the  following  verification  of 
a  position  taken  l)y  the  Secretary,  James 
Russell  Parsons,  in  his  1893  report.  He 
reiterates  that  the  records  of  the  past  year  con- 
clusively prove  the  position  taken  in  his  1893 
report  :  *'  That  the  new  law  proves  a  barrier  to 
the  ingress  of  the  incompetent,  has  operated 
to  raise  the  standard  of  preliminary  education, 
improve  the  methods  of  teaching  and  terms  of 
study  of  the  different  ;-choo!s  of  medicine." 

The  following  resolution  from  the  President 
and  Secretary  of  the  Board  to  the  State  Medical 
Society  is  significan(,  and  should  meet  the  ap- 
proval and  support  of  every  member  of  the 
profession  of  this  great  State  : "  Resolved^ 
That  in  the  opinion  of  this  Board  tlie  best  in- 
terests of  the  public  and  medical  profession 
would  be  materially  advanced  by  gradually 
increasing  the  minimum  of  requirements  as  to 
general  preliminary  education,  till  no  candidate 
be  entitled  to  matriculate  in  1897  at  a  degree- 
granting  medical  school  in  this  State  that  has 
not  completed  at  least  a  full  high  school 
course." 

I  am  pleased  to  note  that  this  bill  has  already 
passed  the  Senate  in  New  York,  and  is  in  a  fair 
way  of  becoming  a  law.  If  it  becomes  opera- 
tive it  will  operate  to  improve  the  character  of 
matriculates  in  New  York  schools,  and  will  be 
followed  by  similar  legislation  in  other  States. 
(Greater  co-operation  is  necessary  between  dif- 
ferent state  boards,  as  it  is  essential  that 
»harmony  of  policy  exist  as  far  as  practicable. 
As  in  foreign  countries  their  relations  to  the 
profession  and  teaching  bodies  is  most  impor- 
tant, their  functions  being  that  of  ])rofessional 
censors  of  the  conduct  of  the  members  of  tlic 
jjrofession,  and  guarding  at  the  same  lime  the 
avenues  of  entrance  to  professional  work.  It 
being  the  duties  of  these  boards  to  protect  the 
jjcople  from  professional  incompetency  and 
charlatanry,  the  duties  are  briefly  comprehend- 
ed in  tlie  performance  of  the  following  duties  : 
I.  In  establishing  a  minimum  curriculum  for 
all  colleges  whose  aiumni  ajiply  for  a  license 
to  practice.  2.  The  individual  examination  of 
all  perons  wishing  to  practice  medicine  in  the 
commonwealth.     3.  A  professional  censorshij) 


granting  the  right  to  refuse  or  revoke  a  license 
for  incompetency  and  gross  unprofessional  or 
dishonorable  conduct. 

As  this  form  of  legislation  becomes  more  fully 
understood  and  appreciated  by  the  better  class 
of  schools,  it  will  be  observed  as  one  of  the 
most  certain  and  reliable  avenues  of  placing 
before  the  profession  of  the  country  the  cha- 
racter of  work  being  done  in  all  colleges  whose 
alumni  apply  for  a  license.  A  school  doing 
honest  work  has  little  to  fear  at  the  hands  of 
these  boards  :  upon  the  contrary,  as  suggested 
in  my  former  paper,  it  will  be  found  that  the 
proportion  of  applicants  able  to  pass  successful 
examinations  will  be  a  certain  index  of  the 
character  of  instruction  afforded  students  in 
the  respective  schools. 

While  the  proportion  of  applicants  successful 
is  only  eighty-two  per  cent.,  it  will  be  found  that 
from  the  schools  heretofore  operating  under  a 
higii  grade  of  requirements  that,  thus  far  at 
least  in  the  work  of  these  boards,  nearly  all 
graduates  a'-e  successful  in  obtaining  a  license 
upon  examination.  In  substantiation  of  this 
conclusion  I  again  submit  data,  using  therein 
the  same  schools  as  in  my  former  paper. 

The  following  table  indicates  the  proportion 
of  students  successful  on  examination  from 
alumni  of  schools  heretofore  operating  under 
the  three  years  curricula. 

Colleges.                Examined.  Licensed.     Rejected.  Percent 

Harvard 31  31  o  i.ooo 

Columbia 123  118  5  .952 

Univ.  of  Penna . . , .    126  123  3  .976 

Univ.  of  Micliigan. .      %2>  7^  5  -94° 

Northwestern  Univ.     26  22  4  .846 

Univ.  of  Minnesota.    149  148  i  .992 

Totals. 53S  520  18  .964 

I  cannot  but  conclude,  gentlemen,  that  effi- 
cient medical  legislation  will  operate  to  bring 
about  ihe  following  results,  as  applied  to  the 
profession  and  public. 

1.  It  will  protect  the  people  by  affording  a 
profession  of  greater  intelligence. 

2.  It  will  suppress  charlatanry. 

3.  It  will  reduce  the  number  of  persons 
practising  medicine  to  a  number  commensurate 
with  the  demands  of  the  people. 

4.  It  will  reduce  the  number  of  medical 
colleges,  at  present  far  above  legitimate 
demands. 

5.  It  will  raise  the  general  standard  of  pro- 
fessional fitness,  assuring  us  a  professional 
prestige  in  the  future,  becoming  the  most 
important  of  the  learned  professions. 

In  conclusion,  we  appeal  to  the  profession 
to  renew  their  efforts  in  securing  efficient  medi- 
cal legislation,  belie\ing  its  operations  will  result 
most  beneficially  to  both  the  public  and  pro- 
fession. 


THE  CANADA  MEDICAL  RECORD. 


221 


MONTREAI.   MEDICO-CHIRHRGICAL 
SOCIETY. 

Stated  Meetings  January  25,  1 895. 
Dr.G.  P.  GiRDwooD,  President,  INTF^E  Chair. 

Large  Interstitial  Uterine  Tumor  luith  great 
Development  of  the  Uterine  iVall  and  Mod- 
erate Increase  of  the  Uterine  Cavity. — Dr. 
Wm.  Gardner  contributed  this  specimen 
and  said  that  it  appeared  to  belong  to  the 
variety  of  myoma,  designated  as  lymphangiec- 
todes  ;  and,  roughly  speaking,  was  composed 
of  intersecting  bands  or  filaments  of  ]jearly 
white  tissue  bounding  spaces  containing  a  clear 
straw-colored  fluid. 

The  case  was  interesting  from  its  rarity,  its 
rapid  growth,  its  consistence  as  felt  through  the 
abdominal  wall,  and  oiherwise  in  some  respects 
presenting  difficulties  in  diagnosis.  T'le 
patient  was  aged  thirty-two,  and  married  eight 
years,  sterile,  menstruation  regular  till  three  or 
four  months  ago,  the  flow  being  copious  and 
painful.  Otherwise  her  complaints  were  of  pain 
in  the  left  lumbar  region  and  in  the  legs,  and  of 
abdominal  enlargement.  The  patient  said  that 
previous  to  a  year  ago  there  was  scarcely  any 
enlargement.  The  abdominal  tumor  re- 
sembled much  in  feel  and  in  other  characters 
the  gravid  uterus  of  seven  months,  .presenting 
at  intervals  the  painless  contractions  so  valua- 
ble a  sign  of  pregnancy,  as  insisted  upon  by 
Dr.  Braxton  Hicks.  The  fact,  however,  that 
this  sign  is  occasionally  met  with  in  the  softer 
varieties  of  uterine  tumors,  was  demonstrated 
by  the  late  Dr.  Matthews  Duncan.  This  con- 
sistence of  the  tumor  and  marked  purplish 
discoloration  of  the  genitals,  with  pigmenta- 
tion of  the  linea  alba,  and  areola  about  the 
nipples,  had  given  rise  to  the  suspicion  of  preg- 
nancy ;  a  suspicion  which  was  shared  by  a 
member  of  the  profession.  The  operation  was 
done  a  fortnight  ago,  and  the  method  chosen 
was  supravaginal  amputation  after  ligature  of 
the  ovarian  and  uterine  arteries,  and  intra- 
p^eritoneal  treatment  of  the  stump.  The 
recovery  had  been  absolutely  witho  ut  unfavor- 
able symptoms. 

Cholecystenteroslomy  from  the  use  of  Murphy's 
Button. — Dr.  Shepherd  at  a  meeting  held  Sep- 
temberaist,  1894,  reported  a  case  of  cholecys- 
tomy  in  whii  h  a  fistula  remained,  and  he  stated 
then  his  intention  of  doing  a  cholecystenteros- 
tomy  should  the  fistula  not  close  within  three 
months.  She  returned  to  the  hospital  November 
28,  1894,  looking  well  and  heaUhy,  and  having 
g  lined  considerably  in  weight.  She,  however, 
said  the  continued  discharge  of  the  bile  was  un- 
bearable, and  asked  that  an  operation  be  per- 
formed for  relief.     So,    on  December  3rd,  she 


was  placed  under  ether,  and  an  incision  was 
made  a  little  internal  fo  the  first  one,  and  the 
fistulous  opening  thus  avoided.  The  gall-blad- 
der was  seen  att:iched  firmly  to  the  abdominal 
wall.  On  examining  the  site  of  the  supposed  gall- 
stones found  at  the  last  operation  in  August,  he 
came  down  on  a  large  mass,  the  size  of  an 
orange,  which  apparently  involved  the  head  of 
the  pancreas  and  duodenum.  Being  convinced 
that  the  case  was  one  of  malignant  disease, 
and  that  all  measures  for  relief  could  only  be 
temporary,  it  was  decided  to  unite  the  gall- 
bladder to  the  colon  by  means  of  a  Murphy 
button,  the  duodenum  being  fixed  and  not  easy 
to  get  at.  The  button  was  introduced  without 
much  difficulty,  the  purse  string  suture  being 
first  applied  ;  owing  to  the  thickness  of  the  gall- 
bladder, there  was  some  puckering,  and  it  was 
difficult  to  get  the  folds  to  lie  flat.  The  thin- 
ness of  the  colon  was  remarked,  and  the  button 
when  pressed  home  could  be  seen  distinctly 
through  the  walls  of  the  gut,  so  a  few  Lembert's 
sutures  were  introduced.  As  the  patient  had 
malignant  disease,  it  was  not  considered  very 
important  to  close  the  fistulous  opening,  as  it 
was  felt  that  this  would  gradually  diminish  in 
size  when  there  was  free  communication 
between  the  gall-bladder  and  the  gut.  On 
dropping  back  the  bowel  and  gall-bladder  the 
parts  seemed  to  lie  quite  comfortably  without 
tension.  The  abdominal  wound  was  now  closed 
with  two  layers  of  sutures. 

The  patient  went  on  excellently  well  for 
three  days,  very  comfortable,  with  no  pain  and 
no  discharge  of  bile  from  the  fistulous  open- 
ing. On  the  evening  of  December  6th,  she 
complained  of  chilliness,  and  bright  red  blood 
began  to  ooze  through  the  fistulous  open- 
ing which  led  to  the  gall-bladder,  and  large 
clots  of  blood  could  be  squeezed  out.  'I'he 
bladder  was  packed  with  iodoform  gauze,  but 
in  a  few  hours  the  blood  began  to  force  its  way 
through  the  abdominal  wound,  and  the  pulse 
began  to  fail,  so  it  was  decided  to  reopen  the 
wound  and  examine  the  source  of  the  haemor- 
rhage. On  opening  that,  however,  the  parts 
were  free  from  any  i>critonitis  or  sepsis,  but 
there  was  a  considerable  amount  of  clotted 
blood  in  the  abdominal  cavity  in  the  neighbor- 
hood of  the  stomach,  besides  a  quantity  in  the 
gall-bladder.  On  examining  the  anastomosis, 
it  was  seen  that  the  button  had  cut  through 
the  gall-bladder,  and  from  this  cut  there  was 
free  bleeding.  There  was  no  gangrene  of  parts 
in  contact  with  the  button.  The  button  was 
immediately  removed  and  the  wound  in  the 
colon  and  that  of  the  gall-bladder  sewed  up. 
In  the  latter,  owing  to  its  great  friability, 
this  was  a  difficult  matter.  Blood  still  came, 
and  so  the  gall-bladder  was  packed  with  iodo- 
form gauze  and  the  wound  closed  as  the  patient 
was  getting  much  weaker.  Next  morning  the 
dressings  were  found  to  be  soaked  with  blood 


222 


THE   CANADA   MEDICAL   RECORD. 


and  all  efforts  to  stop  it  failed.  She  died  that 
evening.  A  hurried  examination  was  made 
after  death,  and  carcinoma  of  the  head  of  the 
pancreas  and  duodenum  was  found,  which 
pressed  the  common  duct.  The  gall-bladder 
was  full  of  blood,  the  suturing  having  failed  to 
arrest  the  haemorrhage.  Dr.  Shepherd  remark- 
ed that  such  cases  as  this  rather  damped  one's 
enthusiasm  for  Murphy's  button,  but  still  the 
case  was  one  of  cancerous  disease,  and  such 
cases  were  more  liable  to  hcemorrhage  than 
others. 

Dr.  James  Bell  had  listened  with  great  in- 
terest to  the  result  of  this  operation.  He  never 
had  occasion  to  apply  the  Murphy  button  in 
the  operation  of  lateral  anastomosis  in  the 
human  subject,  although  he  had  done  so  experi- 
mentally in  the  dog.  However,  he  had  often 
thought  that  a  cholecystenterostomy,  especially 
uniting  the  gall-bladder  to  the  first  portion  of 
the  duodenum,  must  be  a  good  deal  more  diffi- 
cult operation  to  perform  than  it  is  described 
as  being.  The  difficulty  of  suturing  the  gall- 
bladder was  in  his  mind  while  Dr.  Shepherd 
was  describing  his  case.  Since  his  three  cases 
reported  a  few  weeks  ago,  he  had  performed 
another  end  to  end  anastomosis  with  every 
prospect  of  a  satisfactory  result  so  far.  There 
was  a  very  chronic  obstruction,  the  ileum  was 
much  dilated,  the  muscular  coat  of  the  walls 
greatly  hypertrophied,  being  perhaps  2 J  inches 
in  diameter  at  the  point  of  section.  On  the 
other  hand,  the  distal  portion  was  perhaps 
smaller  than  usual.  In  puckering  up  the  purse- 
string  suture  over  the  end  of  the  proximal 
portion  of  the  bowel,  which  was  also  greatly 
thickened,  he  found  difficulty  in  getting  the 
edges  evenly  turned  in,  and  after  uniting  the 
button  he  noticed  some  mucous  membrane 
protruding.  He  then  cut  the  string,  unscrewed 
the  button,  made  another  section,  and  applied 
the  button  a  second  time  with  better  success. 
The  question  of  hasmorrhag't  in  Dr.  Shepherd's 
case  was  a  little  difficult  to  understand.  There 
were  no  large  vessels  to  bleed  in  the  substance 
of  the  gall-bladder  itself,  as  it  is  not  a  vascular 
structure  under  ordinary  circumstances.  His 
first  impression,  upon  hearing  of  the  haemor- 
rhage, was  that  it  came  from  some  portion  of  the 
meso-colon.  It  was  certainly  difficult  to  under- 
stand what  combination  of  circumstances 
could  make  the  gall-bladder  bleed  so  profusely. 
He  could  well  understand  that  an  experience 
of  this  kind  would  not  predispose  a  man  to 
repeated  operations  with  the  Murphy  button. 
He  thought  that  it  iiad  been  used  oftener  than 
advisable  in  cholecystenterostomy.  The  plea 
is,  that  in  a  certain  percentage  cf  these  cases, 
a  fistula  remains  permanently.  On  the  other 
hand,  he  believed  opening  the  duodenum  to  be 
a  great  element  of  danger.  Then  the  history 
of  the  earlier  cases,  those  done  before  the 
Murphy  button  was  introduced,  of  establishing 


a  communication  between  the  gall-bladder  and 
some  portion  of  the  intestines,  was  a  very  un- 
fortunate history  all  through.  Many  cases  of 
inter-communication  of  the  contents  occurred, 
setting  up  disastrous,  if  not  fatal  results. 

Four  cases  of  Extra-Uterine  Pregnancy. 
Dr.  Springle  read   this    paper^  as  follows  : — 

I  shall  not  attempt  to  enter  into  a  consider- 
ation of  the  subject  of  this  condition,  for  it 
may  be  found  occupying  chapter  upon  chapter 
in  any  modern  text  of  gynaecology  or  abdom- 
inal surgery,  and  medical  literature  teems 
with  it.  Still,  I  think  you  will  agree  with  me 
that  one  or  other  of  these  cases  possesses  more 
than  one  point  of  interest. 

'ihis  paper  is  more  properly  a  series  of  four 
case  reports  of  extra-uterine  gestation,  which 
present  so  many  differences  in  their  history 
and  clinical  course  and  effect,  that  I  thought 
perhaps  their  relation  might  be  of  interest  to 
you. 

Two  of  these  cases  were  advanced,  one  to  a 
little  over  six  months,  the  other  somewhat 
less.  The  other  two  were  early  pregnancies 
not  advanced  more  than  three  months.  Again, 
one  of  each  of  the  two  was  operated  upon  and 
the  others  recovered  with  equally  as  good 
results. 

Case  I.  I  first  saw  at  the  Metropolitan 
Dispensary  in  June,  1893,  and  ordered  her  to 
the  Western  Hospital,  where  she  was  admitted 
on  the  15th  of  that  month.  Her  age  was  28 
years,  and  she  had  been  married  nine  years,  and 
had  had  nine  children  and  no  miscarriages.  Her 
youngest  child  was  then.  18  months  old.  She 
had  never,  so  far  as  she  knew,  suffered  from 
any  menstrual  or  other  disorder  bearing  upon 
her  condition  at  the  time.  When  first  seen  at 
the  dispensary  she  was  complaining  of  great 
abdominal  pain  and  enlargement  of  the  abdo- 
men, due  to  a  tumor,  she  had  been  told  by 
her  physician. 

While  in  the  hospital  she  gave  the  following 
history  in  addition  to  that  stated  above  : 

On  february  28,  1893,  she  became  unwell, 
and  continued  to  be  so  until  March  29.  The 
flow  was  accompanied  with  more  or  less  pain, 
which  she  had  not  experienced  belore,  and  at 
no  time  had  she  noticed  shreds  or  pieces 
of  tissue  to  lead  one  to  su|)pose  that 
a  decidual  membrane  had  been  shed.  She 
continued  to  exercise  her  household  duties,  but 
exjDerienced  always  more  or  less  pain  of  a 
lancinating  character  and  situated  more  in  the 
lower  abdomen,  accompanied  by  nausea,  vomit- 
ing, fainting  attacks  and  frequency  of  micturi- 
tion. These  symptoms  continued  up  to  the 
time  when  seen,  and  patient  suspected,  but  was 
not  quite  sure,  that  she  was  pregnant. 

'The  mamma;  and  areola;  were  in  a  condition 
corresponding  to  the  period  of  pregnancy  that 
she  was  sujiposed  to  Iiave  been  in.  '1  he  abdo- 
men   was   enlarged,    tender,    and   with    some 


THE   CANADA   MEDICAL    RECORD. 


223 


slight  difficulty  an  ovoid  in  contour  tumor 
could  be  felt  reaching  to  the  umbilicus  and 
enlarging  below  where  its  outline  to  palpation 
became  lost  in  the  depths  of  the  pelvis.  The 
tumor  was  dull  on  percussion,  very  tender,  no 
contractions  to  be  felt,  no  foetal  movement 
(although  the  patient  thought  she  had  felt 
these),  and  no  heart  sounds  to  be  heard  at  the 
time.     A  well-marked  souffle  was  heard. 

Per  vaginam  the  uterus  was  found  to  be 
crowded  to  the  right  and  front  of  the  pelvis, 
but  its  exact  position  and  location  with  the 
tumor  could  not  be  ascertained  accurately. 
It  was  raised  slightly  and  measured  by  the 
sound  slightly  over  70  m.m.  The  remainder 
of  the  pelvic  cavity  was  filled  by  a  large  fluc- 
tuating tumor  continuous  with  that  observed 
above.  It  was  thought  at  the  time  that  a 
solid  movable  body  could  be  detected,  but  the 
extreme  tenderness  precluded  thorough  mani- 
pulation. Dr.  Fisk,  then  house  surgeon  of  the 
hospital,  detected  fcetal  heart  sounds  upon  the 
day  of  operation. 

When  the  cavity  of  the  peritoneum  was  ex- 
amined, it  was  found  that  the  pelvis  was  roofed 
by  a  tumor  which  had  a  projection  upwards. 
It  completely  filled  the  pelvis  from  the 
brim.  The  uterus  and  right  appendage  were 
easily  felt  in  the  position  partially  ascertained 
by  the  examination  previously  mentioned 
About  one  inch  of  the  left  tube  could  be  felt 
close  to  the  uterus,  the  rest  of  the  tube 
appeared  to  be  lost  or  spread  out  upon  the 
tumor.  Here  and  there  small  and  recent 
clots  of  blood  entangled  in  omentum  and 
lying  in  between  the  folds  of  bowel  were  to  be 
seen.  These  had  evidently  come  from  the  sac 
or  cyst  wall,  in  which  more  posteriorly  several 
small  oozings  were  observed.  Shreds  of  fibrin 
attaching  the  cyst  wall  to  the  surrounding  parts 
were  quite  numerous,  and  evidently  but  a  few 
days  old. 

A  trocar  withdrew  a  quantity  of  unmeasured 
slightly  tinged  with  blood  fluid  from  the  cyst. 
The  puncture  bled  so  freely  that  a  finger  was 
introduced  to  explore  the  contents,  and  which 
was  found  to  be  a  living  child.  The  opening 
was  quickly  enlarged  and  the  foetus  extracted. 
This  was  followed  by  the  most  awful  hsemorr- 
hage  I  have  ever  seen,  and  was  only  controlled 
by  aortic  compression.  The  cord  was  attached 
about  one  and  a  half  inches  to  the  left  of  the 
median  line  to  the  roof  of  the  cavity.  The 
placenta  was  wholly  attached  above,  and  the 
thickness  of  the  placenta  and  cyst  wall  in  parts 
did  not  measure  more  than  one-fourth  of  an 
inch,  and  seemed  to  be  but  peritoneum  and 
placental  tissue. 

Any  attempt  at  hsemostasis  by  ligature,  force- 
pressure  or  cautery  seemed  to  increase  the 
haemorrhage.  The  sac  was  sewn  by  its  open- 
ing to  the  abdominal  opening,  pressure  on  the 
aorta  being  maintained  in  the  meanwhile  and 


the  cavity  tightly  packed  with  iodoform  gauze, 
as  were  also  the  united  openings.  This 
stopped  any  active  haemorrhage.  The  child 
after  delivery  made  a  few  feeble  respirations 
and  died  No  attempt  was  made  to  extract 
the  placeuta. 

The  patient  recovered  well  from  the  efifects 
of  the  anststhetic  considering  the  amount  of 
blood  lost. 

For  several  dressings  in  which  the  gauze 
packing  was  removed  it  was  found  necessary 
to  compress  the  aorta,  and  any  attempt  in 
detaching  the  placenta  was  followed  by  profuse 
haemorrhage. 

She  continued  to  improve  for  ten  days,  after 
which  symptoms  of  thrombosis  appeared  in 
the  left  femoral  vein,  septic  in  nature.  This 
was  followed  by  pysemic  abscesses.  She 
recovered,  however,  but  did  not  leave  the  hos- 
pital until  October  i8th,  and  is  now  in  fair 
health. 

I  am  indebted  to  Drs.  McConnell  and 
Perrigo  for  their  able  assistance  in  this  case 
and  its  after-treatment. 

Case  II.  This  case  is  of  much  interest,  for 
it  is  believed  to  be  now  a  case  of  retained  foe- 
tus. The  patient  was  30  years  of  age  and  had 
been  married  for  six  years.  There  is  a  history 
of  a  probable  miscarriage  (of  about  three 
months)  five  months  after  marriage.  Since 
this  she  had  been  attended  by  a  gynaecologist 
for  some  uterine  disorder.  She  had  enjoyed 
fair  health  otherwise  and  menstruation  had 
always  been  regular. 

On  the  12th  of  September,  1893,  she  was 
seen  for  the  first  time  and  complained  of  pain 
in  the  lower  region  of  the  abdomen,  syncopal 
attacks  and  vomiting.  There  was  a  slight  rise 
of  temperature  and  pulse  rate.  She  had  men- 
struated during  the  last  week  of  March,  nearly 
six  months  previously.  About  the  end  of 
the  following  May  she  noticed  a  slight  flow  of 
blood  and  pieces  of  skin,  as  she  called  them. 
This  was  accompanied  by  violent  cramp-like 
pains,  vomiting  and  fainting.  Her  friends 
thought  she  was  dying.  She  recovered  from 
this  attack,  but  had  more  or  less  pain  in  the 
abdomen  and  occasional  attacks  of  syncope 
until  she  came  under  the  writer's  care. 

She  was  poorly  nourished,  complained  of 
nausea  and  vomiting.  Pulse  was  100  and 
weak,  temperature  100  1-5°-  Pressure  over 
the  abdomen  elicited  much  pain,  and  a  smooth 
immovable,  rounded  mass  was  felt  in  the 
median  line  and  to  the  left  and  in  the  pelvis. 
The  breasts  were  hard  and  tender  and  the 
areola  dark. 

By  bimanual  examination  the  mass  in  the 
pelvis  could  be  felt  ;  it  was  semi-fluctuant, 
tender,  and  was  harder  in  consistency  in  some 
parts  than  others.  The  uterus  was  apparently 
to  the  right  and  front  of  this  mass,  and  could 
not  be  definitely  separated  from  it.     No  foetal 


224 


THE   CANADA   MEDICAL   RECORD. 


movement  or  heart  sounds  were  detected,  nor 
had  the  patient  experienced  any  sensation  of 
nioiion.  No  attempt  to  introduce  a  sound 
into  the  uteiine  cavity  was  made.  She  was 
kept  under  observation  for  a  few  days,  during 
which  time  she  improved. 

She  was  admitted  to  the  Western  Hospital 
on  September  24th,  a  little  over  six  months 
from  the  date  of  her  last  menstrual  period. 
On  admission  a  slight  amount  of  dark  fluid 
blood  was  seen  coming  from  the  vagina  ;  this 
flow  ceased  after  sis  hours. 

The  hospital  records  state  that  fcetal  heart 
sounds  were  to  be  heard.  This,  however, 
could  hardly  have  been  the  case.  Shesuffeied 
fnni  labour-like  pains  from  time  to  time  ;  these, 
however,  passed  off.  During  the  first  week  of 
October  a  large  amount  of  pus  was  passed 
from  the  rectum,  and  has  continued  to  be  dis- 
charged up  to  the  present  time. 

Dr.  Perrigo  advised  operation  before  this 
occurred,  but  was  not  supported  by  the  rest  of 
the  hospital  staff  in  consultation.  She  left  ths 
hospital  some  two  weeks  later  somewhat 
imjircived.  She  was  seen  at  her  home  shortly 
afterwards  and  the  condition  of  the  pelvic  con- 
tents was  as  follows  :  The  uterus  is  pushed  to 
the  right  side  and  front  and  its  outline  can  be 
more  easily  felt ;  it  is  more  moveable.  To  the 
left  of  and  behind  the  uterus  a  large  mass  the 
size  of  a  full  term  fcetal  head  may  be  felt. 
This  is  harder  at  some  parts  than  others  and 
particularly  so  close  to  the  uterus.  Here  a 
rounded  nodule  or  body  is  situated.  Towards 
tlie  left  of  the  pelvis  the  mass  became  more 
ii regular  in  outline.  No  crepitation  or  grating 
can  be  elicited  on  palpitation.  Pus  is  dis- 
charging from  the  rectum,  from  exactly  what 
part  cannot  be  ascertained,  but  the  sinus  must 
be  high  up. 

'i  his  patient  was  seen  quite  recently  and  her 
condition  is  the  same.  The  mass  is  hard, 
nodular  and  somewhat  contracted.  She  suffers 
more  or  less  pain  constantly  in  the  pelvis. 
The  rectal  discharge  continues,  but  is  less  in 
amount.  She  has  not  menstruated  since 
March,  i8(;3. 

This  case  was  looked  upon  when  first  seen 
as  one  of  extra-uterine  gestation.  Although 
perhaps  a  dermoid  tumor  might  simulate  or 
resemble  such  a  condition,  yet  the  history  past 
and  subsequent  is  that  to  be  expected  in  the 
diagnosis  formed. 

Cask  HI,  This  and  the  following  case  are 
instances  in  which  the  primary  rujHure  of  the 
tube  also  caused  the  death  of  the  embryo. 
Both  were  less  th.ni  three  months  pregnant. 

In  one  the  condition  immediately  endan- 
gered life,  in  the  other  the  symptoms  were 
masked.  Indeed  the  condition  of  affairs  was 
not  suspected  before  operation. 

In  the  first  of  these  cases,  a  young  healthy 
looking  woman  of  high  complexion,  25  years  of 


age,  was  sent  to  the  hospital    by   Dr.    Tatley, 

complaining  of  pain  in  the  right  iliac  region, 
and  was  supposed  to  be  due  to  some  chronic, 
probably  gonorrheal,  inflammation  ot  the  lube 
and  ovary  on  that  side. 

She  was  admitted  on  May  23,  1894,  with 
this  history  :  She  has  had  four  chiidrtn,  and 
in  September,  1893,  twelve  monihs  after  the 
birth  of  her  youngest  child,  she  first  complain- 
ed of  pain  on  that  side.  This  had  been  contin- 
uing up  to  the  past  few  weeks,  when  it  became 
worse. 

Two  days  before  admission  she  fell  a  sudden 
sharp  pain  in  the  side  ;  this  was  accompanied 
by  vomiting  and  she  had  to  go  to  bed.  There 
was  no  marked  history  of  concealed  haemorr- 
hage to  be  elicited.  The  pain  ci>niiniied  for 
a  few  hours  and  ceased. 

When  first  seen  she  was  in  good  condition, 
color  and  pulse  normal,  temperature  half  a 
degree  above  normal.  There  was  slight  resist- 
ance to  and  pain  on  pressure  over  the  part 
complained  of. 

I  had  omitted  to  state  that  she  had  been 
regular  and  did  not  suspect  that  pregnancy 
existed.  However,  she  is  not  very  positive  as 
to  the  occurrence  of  menstruation  or  not,  and 
I  hardly  like  to'  accept  her  statements  as 
correct.  On  examination  per  vaginam  an 
enlarged  ovary  and  tube  was  thought  to  be 
present  on  that  side,  and  to  be  aCcornpanied  by 
adhesions. 

On  May  28,  five  days  after  admission,  the 
abdomen  was  opened  and  a  large  amount  of 
clotted  blood  was  found  filling  the  pelvic  peri- 
toneal cavity.  The  tube  on  the  right  side  was 
enlarged  and  ruptured  on  its  posterior  aspect. 
The  rupture  was  large,  and  an  ordinary  pencil 
could  be  inserted  through  it.  It  was  ragged, 
and  a  mass  of  chorion,  etc.,  protruded  through 
it.  Villi  were  found  in  abundance.  The  left 
tube  presenting  signs  of  old  inflammation  was 
removed  also.     Recovery  was  uneventful. 

Case  IV.  In  this  case  the  internal  haemorr- 
hage must  have  been  great.  The  patient  was 
34  years  of  age,  had  had  five  children  and  no 
miscarriages.  Two  years  before,  at  the  time  of 
her  accouchement,  she  had  a  severe  post- 
partum haemorrhage.  Menstrual  history  nega- 
tive. 

She  was  seen  for  the  first  time  on  February 
19,  1894^,  and  was  then  about  eleven  weeks 
pregnant,  as  she  thought.  Three-quarters  of 
an  hour  before,  while  engaged  in  her  house- 
work, she  felt  something  give  way  on  the  right 
side  and  she  fainted  with  pain.  Vomiting  set 
in  and  she  became  so  bloodless  and  weak  that 
the  last  rites  of  the   church  were  administered. 

On  examination  she  was  without  color  to  the 
lil)s,  buccal  mucous  membrane  almost  bloodless, 
sighing  and  gasping  for  breath,  i  he  pulse 
attained  a  rate  of  150  per  minute  when  first 
seen  and  was  hardly  perceptible    at  the    wrist. 


THE  CANADA  MEDICAL  RECORD. 


225 


Speech  was  hardly  audible.  She  had  frequent 
hiccough  and  complained  of  slight  pain  over 
right  iliac  region,  where  some  fullness  was  to 
be  felt  on  palpation  and  dullness  on  percus- 
sion. Some  slight  fullness  was  also  felt  here 
bimanually.  However,  but  little  altem[)t  at 
thorough  examination  was  made,  and  the 
patient  was  disturbed  as  little  as  possible. 
Her  condition  improved  slightly  that  night, 
but  next  morning  she  again  collapsed  and  was 
even  in  a  more  serious  condition  than  at  first 
and  fch  more  pain. 

Dr.  Perrigo  saw  her  with  me  on  the  second 
day  and  concurred  in  the  necessity  for  imme- 
diate operation.  This  was  declined,  and  she 
again  gained  strength  and  again  had  a  hi  of 
collapse  on  the  third  day.  After  this  she 
slowly  and  surely  gained,  and  on  the  fourth  day 
had  slight  intermittent  pain,  followed  by  a  dis- 
charge of  blood  and  decidua.  There  had 
been  no  flow  of  any  kind  for  the  preceding 
eleven  weeks.  A  large  mass  occupied  the 
pelvis,  fixing  the  uterus,  and  it  was  thought 
that  the  ovary  and  part  of  the  tube  could  be 
felt  on  the  right  side. 

She  made  a  tedious  but  complete  recovery, 
and  nothing  more  than  an  induration  and  slight 
enlargement  is  now  to  be  felt  about  the  broad 
ligament. 

Comment. — In  the  first  case  is  an  example 
of  the  most  dangerous  form  of  extra-uterine 
pregnancy  that  could  exist.  It  has  been  said 
by  many  a  writer  that  the  rupture  of  a  gravid 
tube  is  one  of  the  most  dreadful  calamities  to 
which  women  can  be  subjected,  and  anyone 
who  saw  the  loss  of  blood  in  this  case  will 
agree  with  the  saying. 

Women  have  been  known  to  collapse  and 
die  so  suddenly  that  poisoning  has  been  sus- 
pected and  the  case  only  cleared  up  on  au- 
topsy. 

Could  this  case  have  gone  to  full  term,  this 
would  have  been  impossible  ;  rupture  was 
impending  at  the  time  of  operation.  In  any 
case  in  which  a  diagnosis  can  be  made,  or  even 
if  the  condition  be  suspected,  the  only  logical 
and  humane  treatment  is  operative,  and  that  as 
soon  as  possible. 

If  another  case  of  like  nature  be  encountered 
by  the  writer  the  sac  would  be  opened  by  the 
cautery  knife,  with  the  hope  of  less  haemorr- 
hage. 

The  compression  of  the  aorta  was  most 
effectual  here,  and  it  is  to  be  regretted  that 
this  means  has  not  been  more  employed,  espe- 
cially in  controlling  post-partum  hemorrhage. 
It  was  recommended  by  Bishop  in  \\\q  Lancet, 
1893,  and  for  the  past  three  years  the  writer 
has  used  it  with  invariable  results. 

The  removal  of  the  placenta  is  advised  when 
attached  above.  In  this  case  it  would  have 
taken  with  it  the  roof  of  the  sac. 

In  the  second  case  it  is  to  be  regretted  that 


an  early  operation  had  not  been  resorted  to. 
The  present  condition  of  the  sac  communicat- 
ing with  the  bowel  would  complicate  the  usual 
state  of  affairs  greatly,  and  it  is  hardly  to  be 
e.xpected  that  the  patient  in  her  present  condi- 
tion can  enjoy  perfect  health  and  be  free  from 
further  danger.  However,  the  resilt  might 
have  been  worse. 

Whether  this  case  had  a  primary  rupture 
into  the  layers  of  the  broad  ligament  or  into 
the  peritoneal  cavity  is  mere  conjecture,  but 
the  history  would  incline  me  to  favor  the 
former  situation. 

In  the  third  case  the  history  of  cessation  of 
menstruation  is  wanting,  but  this  might  occur 
ii  any  case,  and  would  perhaps  be  misleading 
to  the  attending  physician.  Another  feature 
of  this  case  is  the  absence  of  the  marked  state 
of  collapse  usually  seen  in  this  accident. 

The  interesting  points  in  Case  IV.  lie  in  tiie 
extreme  collapse  observed,  the  occurrence  of 
further  haemorrhages  with  eventual  recovery, 
and  the  absorption  of  the  greater  amount  of 
clot. 

Dr.  HiNGSTON  said  that  some  years  ago  Dr. 
D'Orsonnens,  a  very  distinguished  accoucheur 
in  Montreal,  mentioned  a  number  of  cases  in 
which  no  operation  was  performed,  and  where 
the  patients  ultimately  made  good  recoveries. 
He  (Dr.  H.)  saw  two  of  the  cases  to  which  Dr. 
D'Orsonnens  alluded,  where  the  foetus  came 
away,  piecemeal,  through  the  abdominal  wall 
in  one  case,  and  through  the  rectum  in  the 
other.  Dr.  D'Orsonnens'  experience  in  the 
Maternity  and  in  private  practice  went  to  prove 
that  in  extra-uterine  pregnancy  rupture  did  not 
necessarily  follow,  and  that  when  rupture 
occurred,  death  did  not  necessarily  take  place. 
Sometimes  nature  was  sufficient  to  bring  the 
child  into  the  world.  He  (Dr.  H.)  had  an  in- 
stance of  this  four  years  ago.  He  was  asked  by 
a  medical  gentleman  of  this  city  to  see  a  lady 
for  the  purpose  of  removing  what  was  con- 
sidered an  ovarian  tumor.  He  saw  the  lady, 
examined  her  carefully,  found  the  uterus  per- 
fectly free;  depth  of  cavity  normal,  yet  there 
was  a  large  swelling,  more  to  the  right  side 
than  to  the  left,  and  on  close  examination  he 
came  to  the  conclusion  it  was  not  a  tumor, 
but  partly  interstitial,  partly  tubal  pregnancy. 
He  advised  the  operation  to  be  put  off  till  the 
seventh  month.  The  lady  was  again  seen  at 
the  seventh  month,  and  being  in  excellent 
health,  the  operation  was  deferred  till  the 
eighth  month.  About  the  time  when  the  opera- 
tion was  to  take  place,  being  in  the  neighbor- 
hood, he  called  on  the  lady,  and  while  talking 
to  her  something  like  labor  pains  came  on.  On 
examination  he  found  the  os  uteri  dilated,  and 
the  membranes  projecting  from  the  side  of 
and  into  the  uterus.  He  suggested  that  an 
accoucheur  be  sent  for  and  left.  He  learned 
afterwards   that  the  child    was    born    without 


226 


THE   CANADA   MEDICAL   RECORD. 


difficulty  in  the  natural  way.  Buth  parent  and 
child  were  alive  to-day.  He  merely  mentioned 
this  case  to  show  that,  in  some  instances,  ex- 
ceptional, no  doubt,  interference  was  not 
necessary,  and  that  especially  when  fcetation 
was  partly  interstitial  and  partly  tubal.  Dame 
Nature  may,  and  does,  sometimes  dispense 
with  our  art. 

Uterine  J'il>roiii.  —  \)T.  Lapihorn  Smith 
exhibited  a  fibroid  uterus  which  he  had  reaioved 
fifteen  days  previously  from  a  German  woman 
at  the  Samaritan  hospital.  The  patient  was 
thirty-five  years  of  age,  but  looked  much  older, 
and  was  very  anaemic  from  menorrhagia,  the 
flow  being  very  profuse  and  lasting  fifteen  days. 
Although  this  had  been  going  on  for  five  years, 
it  was  only  during  the  last  three  years  that  she 
had  noticed  the  tumor  which,  when  she  came 
under  observation,  m  ide  her  appear  the  size  of 
a  woman  seven  months  pregnant.  The  method 
employed  was  that  followed  by  Bantock  and 
Price  and  Tait,  by  serre-noeud  and  the  ex- 
tra-peritoneal treatment  of  the  stump.  The 
tumor  weighed,  when  fresh,  about  fifteen  pounds, 
was  symmetrically  oval,  smooth  and  dense, 
and  had  two  small  subperitoneal  fibroids  on  top 
of  it  between  the  ovaries,  which  latter  were  large. 
The  serre-ntuud  had  been  removed  on  the  6ih 
day,  and  the  slump  cut  away  on  the  12th  day. 
The  paiient  was  eating  well,  and  pulse  and 
temperature  had  hardly  gone  above  normal, 
100^  for  one  night  only.  She  was  now  sitting 
up  a  little  every  day.  While  admitting  the 
many  advantages  of  the  new  method  by  which 
no  stump  at  all  is  left,  he  felt  safer  with  the 
extra-peritoneal  method,  and  still  employed  it 
whenever  he  was  particularly  anxious  for  the 
patient  to  recover,  or,  in  other  words,  in  every 
case. 

Dr.  HiNGSTwN  thought  there  weiesome  cases 
where  the  operation  must  necessarily  be  intra- 
peritoneal, and  when  it  could  be  performed  it 
was  also  the  better ;  but  there  were  cases  where 
the  extra-peritoneal  was  the  belter  opera- 
tion. He  had  operated  by  both  methods,  and 
while  he  gave  the  preference  to  the  intraperito- 
neal  method,  he  found  that  each  had  advantages 
in  certain  cases.  Much  depended  upon  the 
length  of  the  cervix,  the  nature  of  the  tumor, 
and  the  facility  or  otherwise  with  which  the 
stump  could  be  drawn  through  the  abdominal 
wound. 

Dermoid  Cyst—'DT.  Lapthorn  Smith  ex- 
hibited a  dermoid  cyst  of  the  right  ovary, 
which  he  removed  a  week  before  at  his 
private  hospital,  from  a  lady,  fifty-six  years 
of  age,  who  was  suffering  great  pain,  as  well 
as  from  profuse  menstruation.  On  examina- 
tion, the  uterus  was  found  to  be  enlarged, 
there  being  several  small  fibroids  in  its  anterior 
wall,  and  the  cervix  was  badly  lacerated,  while 
a  solid  tumor,  the  size  of  a  small  orange, 
occupied    Douglas    cul-de-sac.     She  was  very 


weak  from  these  haemorrhages,  which  began  ten 
years  before  and  had  gradually  increased.  The 
periods,  however,  had  never  ceased  at  the  usual 
age  for  the  menopause.  The  uterus  was 
curetted,  the  cervix  repaired,  and  the  dermoid 
cyst  and  the  other  ovary  removed.  She  suffered 
so  little  pain  that  she  did  not  even  require  the 
hyiiodermir  injection  of  a  3i(  grain  of  morphia, 
which  he  always  allowed,  while  she  declared 
herself  to  be  absolutely  free  from  pain  the  day 
following  the  operation.  The  object  of  re- 
moving both  ovaries  was  to  put  a  stop  to  the 
menorrhagia.  On  cutting  open  the  cyst  it  was 
seen  to  contain  an  outside  layer  of  pure  white 
sebaceous  matter  around  a  central  ball  of  hair  ; 
but  it  contained  no  teeth.  The  operation  pre- 
sented no  difiiculties,  and  illustrated  the  import- 
ance of  recognizing  and  removing  the  tumors 
while  they  were  yet  small. 

Foreign  Body  in  the  Bladder — Dr.  Kingston 
exhibited  a  wax  candle  which  he  had  removed 
from  the  bladder  of  a  lady  who  had  been  using 
it  for  purposes  of  sensual  gratification.  On 
the  last  occasion,  which  to  her  would  be  a 
memorable  one,  it  slipped  from  her  finger  and 
was  seen  no  more.  She  suffered  intense  pain 
in  consequence,  and  finally  was  compelled  to 
seek  surgical  aid.  After  successively  ex  imin- 
ing  the  v.igina  and  rectum  and  bladder,  Dr. 
Hingston  located  the  foreign  body  completely 
within  the  latter  organ  (the  patient  only  knew 
it  had  gone  "  somewhere  down  there").  He 
removed  portions  of  it  with  bullet  forceps,  but 
owing  to  the  softness  of  the  wax  those  portions 
were  inconsiderable.  He  therefore  ordered  the 
paiient  to  the  hospital,  where,  after  chloroform 
had  been  administered,  he  succeeded  in  re- 
moving the  whole  of  the  candle,  the  longest 
piece  measuring  five  and  a  half  inches  in 
length,  the  last  and  largest  piece  having  been 
removed  with  a  lithotomy  forceps,  such  as  is 
used  for  children.  The  most  interesting  feature 
in  the  case  was.  Dr.  Hingston  remarked,  the 
facility  with  which  he  could  manipulate  his 
finger,  and  an  instrument  upon  it,  through  the 
urethra.  It  probably  did  not  take  more  than 
ten  or  twelve  minutes  for  him  to  gain  an  en 
trance  to  the  bladder  with  the  lithotomy  for- 
ceps and  the  finger  to  guide  it.  There  was 
very  little  suffering  experienced  afterwards 
from  the  operation,  and  no  incontinence  of 
urine  resulted  from  it. 

Dr.  F.  W.  Campbell  mentioned  several 
somewhat  similar  cases  which  had  occurred  in 
the  practice  of  the  late  Prof.  Syme,  during  his 
attendance  at  the  Royal  Infirmary,  Edinburgh. 
He  also  described  a  case  which  he  had  seen  at 
the  Montreal  General  Hospital,  where  the  late 
Dr.  Thomas  Walter  Jones  removed  from  the 
uretiira,  by  perineal  section,  a  carpenter's  lead 
pencil.  (3ne  case  which  occurred  in  his  own 
practice  some  years  ago,  was  that  of  a  young 
man  who   came  to  his  office  and  said    that  h^ 


THE  CANADA  MEDICAL  RECORD. 


227 


had  been  waylaid  and  two  large  pins  pushed 
into  his  ureihra — the  heads  downwards.  It 
was  impossible  to  remove  them  via  meatus,  so 
the  points  were  pushed  through  the  sides  of 
the  penis  and  a  small  incision  made  to  liberate 
the  heads.  The  present  case  was  the  first 
the  speaker  had  heard  of  where  the  female 
urethra  was  used  for  such  a  purpose,  although 
those  in  which  the  vagina  was  used  were  not 
very  rare. 

The  late  Dr.  E.  E.  D liquet— The  following 
resolution  was  moved  by  Dr.  Hingston  and 
seconded  by  Dr.  Burgess  : — 

"  That  this  Society  desires  to  record  its 
sense  of  the  loss  sustained  by  the  profession 
generally,  and  mental  science  more  especially, 
by  the  recent  death  of  Dr.  Duquet,  who,  in  a 
quiet  and  unobtrusive  manner,  had  secured 
the  respect  and  confidence  of  his  professional 
brethren  in  Montreal,  and  the  esteem  and 
consideration  of  the  more  eminent  alienists 
elsewhere. 


stated  Meet'mg,  '^.th  February,  1895. 

Dr.  G.  P.  GiRDwooD,  President,  in  the 
Chair. 

Ferforated  Gastric  Ulcer — Dr.  Kirkpa- 
TRiCK  brought  before  the  Society  a  patieht  on 
whom  he  had  operated  for  this  cause. 

As  this  case  is  one  of  more  than  usual 
interest,  1  bring  the  patient  before  you  to-night 
to  show  how  perfectly  recovery  has  taken 
place.  The  history  is  as  follows,  and  for  it  I 
am  indebted  to  my  house-surgeon,  Dr.  Byers. 

Fanny  R.,  aged  24,  native  of  Ireland,  ser- 
vant girl  by  occupation,  was  admitted  into  the 
Montreal  General  Hospital  on  Nov.  17th, 
complaining  of  "  pain  in  the  abdomen  and 
shoulders." 

Patient  gave  the  history  of  having  been 
seized  on  Thursday  morning  (2  o'clock),  Nov. 
15th,  with  severe  pain  in  the  epigastrium  and 
lower  substernal  regions,  which  caused  her  to 
suffer  intensely,  and  along  with  this  she 
vomited  "  dark-colored  "  material  for  several 
hours.  The  condition,  except  for  additional 
pain  felt  in  the  shoulders,  continued  thus  una- 
bated in  spite  of  treatment,  and  she  entered 
the  hospital  on  Saturday  afternoon,  Nov.  17th. 
Was  uncertain  when  asked  as  to  the  condition  of 
her  bowels  during  this  time. 

In  addition  to  the  above,  patient  gave  an 
indefinite  history  of  having  been  under  treat- 
ment two  years  before  for  shortness  of  breath 
on  exertion,  pallor,  headache,  amenorrhoea, 
etc.,  symptoms  of  chlorosis,  and  of  having 
had  during  the  month  previous  to  the  onset  of 
her  major  illness,  pain  in  the  region  of  her 
stomach,  sometimes  severe,  and  coming  on 
immediately  after  eating,'  and  sometimi;s  felt 
between  the  intervals  of  taking  food.  Walk- 
ing, particularly   upstairs,    rendered  the  condi- 


tion worse,  and  the  pain  seemed  to  have  grown 
more  severe  during  the  few  days  preceding  the 
attack  of  Thursday,  Nov.  15th.  Occasionally, 
the  patient  said,  she  had  "felt  sick  at  her  sto 
mach,"  but  she  never  had  vomiting  of  blood, 
nor  did  she  at  any  time  notice  anything  pecu- 
liar about  her  motions.  Of  late,  also,  her 
appetite  hnd  been  very  poor  and  cnpncious, 
and  her  strength  and  general  health  much 
impaired. 

When  seen  first  after  admission,  patient  was 
lying  in  bed  in  the  dorsal  position,  with  her 
legs  drawn  up,  moaning  and  in  great  distress. 

Her  face  was  pallid,  and  lips  dry.  She  com- 
plained of  pain  in  the  abdomen,  particularly 
in  the  epigastric  region,  and  in  the  shoulders, 
especially  the  left.  The  tongue  was  brownish, 
fissured  and  dry  in  the  centre,  whitish  and 
moist  at  the  edges.  Sordes  present  in  the 
teeth. 

She  complained  somewhat  of  being  thirsty, 
but  was  not  sick  at  her  stomach,  and  had  no 
inclination  to  vomit. 

The  abdomen  was  prominent  and  rounded, 
and  evenly  distended. 

Tenderness  general,  but  particularly  marked 
in  the  epigastric  and  innermost  portion  of  the 
hypochondriac  regions.  Tenseness  of  the 
abdominal  walls  was  not  great,  and  not  more 
marked  in  any  special  region.  No  evidences 
of  tumor  in  any  situation.  Percussion  revealed 
a  general  tympanitic  note,  which  mounted 
up  and  completely  obscured  the  liver  dullness. 
The  urine  was  high-colored,  with  thick  cloudy 
deposit,  spec,  grav.,  1.032;  reaction  acid; 
albumen  |  resent  in  appreciable  quantities  ; 
casts  and  leucocytes  found  on  microscopical 
examination.  Respiratory  and  vascular  sys- 
tems normal ;  temp.  101.5;  pulse,  120;  respir- 
ation, 44. 

As  the  patient  did  not  improve  during  the 
night,  it  was  decided,  after  consultation  with 
Dr.  Armstrong,  that  the  condition  was  one  of 
perforated  ulcer  of  the  stomach,  and  that  the 
only  hope  was  immediate  operation.  Accord- 
ingly the  operation  begaii  at  2  o'clock  in  the 
afternoon  ;  the  details  are  as  follows  : 

An  incision  was  made  from  the  ensiform 
cartilage  to  within  a  short  distance  of  the 
umbilicus.  On  opening  the  peritoneum  a 
small  quantity  of  gas  escaped  and  the  anterior 
wall  of  the  stomach  presented.  This  was 
found  to  be  attached  to  the  parietes  by  slight 
adhesions,  wliich  were  easily  broken  down  by 
the  fingers. 

On  disturbing  the  viscera  thus,  more  gas 
escaped  from  the  abdominal  cavity,  and  while 
assisting  me  to  break  down  the  adhesions.  Dr. 
Armstrong's  finger  slipped  into  the  hole  in  the 
stomach.  Gauze  pads  were  immediately 
packed  around  the  opening  in  order  to  prevent 
escape  of  the  stomach  contents,  and  then  Dr. 
Armstrong  withdrew  his  finger.     The   stomach 


228 


THE    CANADA    MEDICAL   RECORD. 


was  drawn  up  through  the  wound  and  exam- 
ined. Tlie  ulccf  was  situated  in  the  anterior 
wall  of  the  stomach,  a  little  to  the  right  of  the 
oesophageal  line,  and  moie  toward  the  superior 
and  inferior  gastric  border.  The  opening  was 
a  little  larger  than  a  five  cent  piece,  and  was 
closed  with  a  continuous  Czerney-Lembert 
suture  after  trimming  the  ragged  edges  with  a 
pair  of  scissors.  The  Lembert  suture  was  con- 
tinued f<ir  about  half  an  inch  toward  the 
median  line,  in  order  to  invert  a  portion  of 
stomach  wall  that  looked  as  if  ulceration  might 
be  go  ng  on  inside.  The  abdomen  was  then 
sponged  out,  a  rubber  tube  inserted  into  the 
right  flank  and  the  edges  of  the  incision 
brouglit  together  by  through  and  through 
stitches  of  silkworm  gut.  Irrigation  of  abdo- 
men was  not   used. 

During  the  operation  the  patient's  pulse 
became  very  weak,  but  on  being  put  back  to 
bed  she  came  quickly  out  of  ether,  with  little 
pain  or  vomiting.  The  pulse  improved  quick- 
ly, stimulation  being  required  on  only  one 
occasion  when  strych.  gr.  1-50  was  given. 
Exudation  was  very  slight,  only  3  r  ss.  clear 
fluid  coming  av/ay,  ?o  that  the  drainage  tube 
was  removed  on  the  following  morning,  after 
20  hours.  All  food  by  mouth  was  prohibited 
at  first,  patient's  strength  being  maintained  by 
nutrient  enemata  of  beef  tea  and  peptonized 
milk.  On  the  third  day  small  quantities  of 
milk  were  given  by  the  mouth.  The  patient 
was  dressed  on  Nov.  23rd  and  again  on  Dec. 
3rd,  when  the  stitches  were  removed.  The 
wound  healed  by  first  intention.  Slight  sup- 
juiration  occurred  in  the  upper  part  of  the 
incision,  and  a  small  sinus  appeared  fiv^e  weeks 
afier  the  operation. 

This  appeared  to  be  due  to  the  working 
forward  of  a  bit  of  deep  gastric  suture,  which 
could  be  felt  as  a  rough  body  at  the  bottom  of 
the  sinus.  The  patient  sat  up,  o  ;t  of  bed,  on 
Dec.  19th,  and  since  then  her  general  health 
has  been  improving  steadily.  The  tempera- 
ture was  normal  on  the  thirteenth  day  follow- 
ing the  operation.  The  sinus  has  now  healed 
and  the  patient  is  perfectly  well. 

T^  operation  has  been  performed  a  numbe 
of  limes,  but  so  far  very  few  successful  cases 
have  been  reported.  At  the  meeting  of  the 
British  Medical  Association  last  summer 
{British  Med  cal  Journal.,  October  20,  1895), 
the  subjtict  came  up  for  discussion,  and  at  that 
time  only  five  successful  cases  had  been 
reported.  The  operators  were  Taylor,  Kriege, 
Morse,  Maclaren  and  Gilford.  M.  P.  Michaux, 
of  Paris  {Bui/ tin  M,d.  Oct.  24//^,  1894) 
reports  a  successful  case  and  mentions  another, 
that  of  Roux,  of  Lausanne.  Lastly,  R.  H. 
IJourchier  Nich(jlson  reports  a  case  {Brit. 
Med.  Journal^  Nov.  3  and  De  .  22,  1S94). 
This  makes  a  total  of  nine  rases  reported  up 
to  date. 


Dr.  x\r.mstrcng  congratulated  Dr.  Kirk- 
patrick,  and  tho-ight  it  was  a  credit  to  the 
Society  for  one  of  its  members  to  have  re- 
CDgnized  this  condition  and  peiformed  opera- 
tion. He  believed  that  this  promised  to  be  a 
field  in  which  a  great  deal  of  useful  surgery 
might  be  done;  and  physicians  should  be 
stimulated  to  the  early  recognition  of  such 
cases.  .Although  ulcers  were  more  common 
on  the  posterior  wall,  rupture  or  perforation 
was  more  apt  to  occur  on  the  anterior,  which 
was  fortunate,  as  of  course  it  was  m^ie  easy  to 
reach  the  anterior  wall  of  the  stomach. 

Dr.  GuRD  said  that  he^had  been  attending 
the  girl  for  about  a  week  before  sending  her 
to  hospital.  She  had  been  suffering  from  the 
usual  symptoms  of  anaemia  with  gasiralgia. 
The  pains  in  the  stomach  came  on  periodically 
about  four  or  five  o'clock  every  afternoon,  and 
appeared  to  shoot  up  to  the  upper  part  of  t!ie 
chest.  She  was  able  to  attend  to  her  duties, 
those  of  housemaid,  when  suddenly  in  the 
night  she  was  seized  with  severe  pains  in  the 
epigastrium.  Dr.  Gurd  was  asked  by  her 
employer  for  something  to  relieve  her.  He 
sent  a  }(  grain  of  morphia.  The  next  day  he 
found  the  pain  not  very  great,  but  much  in- 
creased on  pressure;  temperature  about  101°. 
The  following  day  all  the  symptoms  were  rather 
worse,  and  an  attempt  to  get  her  into  the 
hospital  was  made,  but  without  success.  Two 
days  went  by  before  she  could  be  admitted, 
during  which  ti.iie  she  had  been  growing  worse, 
so  much  so  that  few  who  saw  her  before  the 
operation  thoijght  she  could  recover. 

Dr.  Engl.wd  said  this  case  lecalled  to  his 
mind  a  case  reported  by  Dr.  Armstrong,  about 
3  years  ago,  to  whom  he  administered  the 
ether.  The  case  was  that  of  a  y^iing  lady,  22 
years  old,  who  was  suddenly  seize- i,  while  at  a 
sorial  party,  with  severe  abdominal  pain.  Her 
previous  health  had  been  fairly  good,  though 
she  had  at  times  been  troubled  with  indigestion, 
and  was  rather  anaemic.  The  pains  continued 
in  spite  of  treatment  by  the  local  physician  and 
peritonitis  developed.  Seven  or  eight  days 
after  ihe  onset  of  pain.  Dr.  Armstrong  saw  the 
case  and  recommended  operation.  Laparo- 
tomy was  |)erformed,  the  incision  was  made  in 
the  middle  line  below  the  u;nbilicus.  General 
peritonitis  was  found  to  exist.  The  appendix 
vermiformis  was  located  ind  removed,  also 
the  uterine  appendages,  the  latter  not  being 
healthy,  and  the  wound  closed.  The  patient 
died,  he  believed,  on  the  following  day,  and 
the  autopsy  revealed  two  large  ulcers  whuh  had 
])erforated  the  walls  of  the  stomach,  the  per- 
foration probably  having  occurred  at  the  on- 
set of  pain,  allowing  the  contents  of  the  stomach 
to  escape  into  the  peritoneal  cavity.  On  open- 
ing the  abdomen  it  was  found  that  firm  adhe- 
sions had  formed  at  about  the  level  of  the 
umbilicus,  (.".ividing  the  abdominal   cavity  into 


THE   CANADA   MEDICAL   RECORD. 


229 


two  zones.  Into  the  upper  tjie  contents  of  the 
stomach  continued  to  escape  from  the  time  of 
perforation  until  death.  The  lower  zone 
showed  signs  of  more  recent  and  severe  iiflam- 
mation.  His  object  in  alluding  to  this  case 
was  to  show  that  peritonitis,  following  perfora 
tion  of  a  gastric  ulcer,  was  not  so  virulent  in 
character  as  was  peritonitis  from  pei  forati(3n  of 
an  inflamed  appendix  or  other  intestinal  ulcer. 
Peritonitis  in  both  these  cases  was  slow  in  its 
development  and  of  a  subacute  character  ;  so 
different  from  the  peritonitis  which  one  expects 
to  find  when  the  bowel  is  ruptured  or  a  pus 
tube  breaks,  and  its  contents  esca[)e  into  the 
peritoneum. 

Dr.  Armstrong  remembered  the  case  re- 
ferred to  by  Dr.  England,  and  it  was  owing  to 
that  and  one  or  two  similar  experiences  that 
he  acquired  sufficient  knowledge  to  recognize 
the  condition  and  its  seriousness  in  Dr.  Kirk- 
patrick's  case.  In  this  way  even  our  mistakes 
prove  beneficial  to  mankind.  He  thought  that 
it  was  these  cases  without  any  distinct  history 
which  were  apt  to  rupture.  The  girl  alluded 
to  by  Dr.  England  had  been  dancing  when  the 
rupture  occurred. 

Gall  Stones. — Dr.  Armstrong  showed  two 
lots  of  gall-stones.  The  first  bottle  passed 
around  contained,  according  10  a  count  made 
by  one  of  the  students,  637  stones.  This  was 
a  large  number,  but  of  course  much  larger 
numbers  had  been  remwved.  The  chief  inter- 
est of  the  case  was  in  the  clinical  history. 

Patient,  a  female,  ^et.  64,  was  admitted  to  the 
Montreal  General  Hospital  complaining  of  pain 
in  the  right  hypochondrium.  The  pain  was  so 
severe  that  morphia  was  given  hypodermically 
to  relieve  it.  She  had  had  a  little  jaundice, 
lasting  a  short  time,  some  three  months  before 
admission.  The  patient  had  the  appearance  of 
a  woman  suffering  from  malignant  disease.  She 
was  pale  and  cachectic. 

,  The  operation  was  begun  as  an  exploratory 
incision,  with  the  idea  of  removing  gall-stones 
if  they  were  found,  and  if  malignant  disease, 
the  patient  would  be  none  the  worse. 

On  opening  tlie  abdomen,  the  gall  bladder 
containing  these  stones  was  readily  found,  and 
fortunately  for  the  patient,  no  evidence  of 
carcinoma  about  this  organ,  liver  or  pancreas 
was  discovered,  with  the  exception  of  one 
enlarged  freely  movable  lymphatic  gland.  As 
he  could  not  bring  the  edges  of  the  gall-bladder 
to  the  edge  of  the  abdominal  incision,  and  tliere 
was  evidence  of  the  patency  of  the  cystic  and 
common  duct,  Dr.  Armstrong  closed  the  open- 
ing of  the  gall-bladder  and  dropped  it  back. 
He  ihen  passed  a  glass  drain  down  to  the 
suture  line  in  the  gall-bladder  as,  if  any  bile  had 
escaped  from  the  gall-bladder,  the  condition 
would  have  been  the  same  as  if  the  gall-bladder 
had  not  been  sutured.  The  patient  made  a 
perfect    recovery.     An    additional    reason    for 


operating  for  gall-stones  in  elderly  people,  was 
that  the  injury  and  local  irritation  caused  by 
their  presence  might  be  an  exciting  cause  of 
malignant  disease.  The  association  of  gall- 
stones and  malignant  disease  in  the  neighbor- 
hood of  the  gall-bladder  had  long  been  noted. 

The  second  bottle  contained  a  lot  of  gall- 
stones which  had  been  removed  post-mortem 
by  Dr.  Stenning,  of  Coaticooke.  Their  in- 
terest was  in  the  fact  that  there  were  3  pretty 
large  stones,  with  78  small  ones.  Mr.  Tait  had 
drawn  attention  to  the  fact  that  as  a  general  ru!e 
gall-stone  cases  were  divided  into  two  distinct 
classes.  In  the  first,  there  was  one,  two,  or 
three,  seldom  more,  large  stones,  and  in  the 
second  a  large  number  of  small  stones.  This 
VMS  the  first  instance  coming  under  the  notice 
of  Dr.  Armstrong  in  which  the  small  and  large 
stones  were  found  together  in  the  same  case. 

Dr.  Adami  agreed  that  it  was  very  unusual 
to  find  large  and  small  gall  stones  together  in 
one  case.  With  reference  to  what  Dr.  Arm- 
strong had  remarked  concerning  the  etiological 
relationship  between  gall  stones  and  hepatic 
carcinoma,  he  reminded  the  Society  that  during 
this  session  he  had  exhibited  a  case  in  which 
this  relationship  appeared  to  exist,  a  case  in 
which  the  bladder,  full  of  gall  stones,  had 
become  the  seat  of  a  suppurative  inflammation, 
and  cancer  of  the  liver  substance  developed 
immediately  outside  the  chronically  inflamed 
bladder. 

A  Case  of  Multiple  Carcinomatoics  Growths 
in  a  Cirrhosed  Liver. — Drs.  FiNLEVand  Ad.'^mi 
brought  forward  this  case,  which  was  of  interest 
both  from  a  clinical  and  anatomical  standpoint. 
Dr.  Finley  read  the  following  history  of  the 
case  : 

C.  D.,  aet.  50,  an  Italian  laborer,  was  admit- 
ted to  the  Montreal  General  Hospital,  Decem- 
ber 24,  1894,  complaining  of  swelling  of  legs 
and  abdomen. 

Personal  History— Hq  has  always  been  ex- 
tremely temperate, and  has  not  had  any  venereal 
disease.  He  has  enjoyed  good  health  up  to  the 
onset  of  the  present  illness.  The  family  history 
is  unobtainable  as  the  patient  speaks  but  little 
English.  The  present  illness  began  on  the  25th 
of  October,  with  severe  pain  in  the  right  hypo- 
chondrium radiatmg  over  the  abdomen.  A 
month  later  the  abdomen  began  to  swell  and 
the  pain  disappeared.  He  has  lost  much  flesh 
and  strength. 

Present  Condition — He  is  much  emaciated, 
the  cheek  bones  are  prominent  and  the  muscles 
small  and  soft.  A  moderate  degree  of  jaun- 
dice is  present,  the  conjunctivae  being  yellow 
and  the  skin  brownish-yellow  in  color.  The 
tongue  is  heavily  coated,  the  bowels  constipated 
and  the  appetite  poor.  The  temperature  ranges 
from  97°  to  99°,  pulse  88  and  of  good  volume. 
The  abdomen  is  much  distended,  and  enlarged 
veins  are  seen  in  the   flanks   and  over  the  right 


230 


THE  CANADA   MEDICAL    RfiCOfeD. 


hvpochondrium.  The  presence  of  a  large 
quantity  of  free  fluid  is  indicated  by  movable 
dulness  and  fluctuation.  There  is  distinct  ful- 
ness in  the  hepatic  region,  both  in  front  and 
behind  about  the  angle  of  the  scapula.  Hepatic 
dulness  extends  from  the  fifth  rib  to  a  hand's 
breadth  below  the  costal  margin  and  measures 
six  inches.  Tiie  edge  of  the  liver  can  be  felt 
tlirough  the  fluid.  Spleen  is  not  palpable.  The 
freces  are  colored,  the  urine  very  dark,  with 
a  dejiosit  of  amorphous  urates;  acid,  S.G.  1020; 
no  albumen,  no  sugar.  Urobilin  with  Hup- 
peri's  lest.  Tested  for  bile  witli  nitric  acid  only 
a  purple  ring  on  filter  paper. 

December  26,  8;  oz.  of  clear  yellow  fluid 
withdrawn  with  the  aspirator.  After  paracen- 
tesis the  lowr  end  of  the  spleen  is  distinctly 
felt.  '1  he  hepatic  enlargement  involves  the 
right  lobe  only,  its  border  passing  beneath  the 
ribs  at  the  right  parasternal  line.  The  surface 
is  slightly  nodular  and  hard.  Early  in  Janu- 
ary nourishment  was  refused  and  rectal  tenes- 
mus with  small  clay-colored  stools  set  in. 
Death  occurred  on  January  6th,  being  pre- 
ceded by  delirium,  involuntary  evacuations  of 
urine  and  a  semi-comatose  condition. 

The  diagnosis  lay  between  cirrhosis  and 
carcinoma  of  the  liver,  the  former  being 
specially  suggested  by  the  enlarged  spleen. 
The  rapid  emaciation,  together  with  enlarge- 
ment of  the  liver,  an  enlargement  which  it  will 
be  noted  involved  only  the  right  lobe,  was, 
however,  strongly  in  favor  of  cancer,  as  was 
also  an  absence  of  an  alcoholic  history. 
Obstruction  to  the  portal  system  evidenced  by 
ascites  would  also  explain  the  splenic  enlarge- 
ment. Urobilin  and  not  biliverdin  was  con- 
stantly present  in  the  urine,  a  fact  which  has 
been  specially  noted  by  Jakseh  in  the  jaundice 
of  hepatic  disease. 

Dr.  Finlp:v  stated  that  at  the  autopsy  per- 
formed by  himself  and  Dr.  Williams  the  body 
was  found  deeply  jaundiced.  The  abdomen 
contained  a  large  amount  of  fluid. 

The  liver  weighed  4140  grms  ;  its  right  lobe 
was  greatly  enlarged,  extending  below  the 
costal  border,  and  it  was  thickly  studded  with 
yellow  nodules  varying  in  size  from  that  of  a 
small  shot  to  that  of  a  walnut.  The  larger 
nodules  were  friable  and  caseous  in  the  centre. 
The  left  lobe  had  a  roughened  cirrhotic  sur- 
face, was  firm  and  somewhat  diminished  in 
size.  Both  externally  and  on  section  it  pre- 
sented the  appearance  of  an  atrophic  ciirhosis. 
No  nodults  Were  discovered  in  it. 

'J'he  spleen  was  greatly  enlarged  (1060 
grms.)  and  firm.  To  the  naked  eye  the  condi- 
tion resembled  that  of  cancer  of  one  lobe  and 
cirrhoi-is  of  the  other,  and  sufficed  to  ex])lain 
the  symptoms  whicli,  as  above  noted,  were 
those  both  of  cancer  and  cirrhosis. 

Dr.  Adami  described  the  microscopical 
appearances  of  the  liver.     The   right  lobe  on 


section  had  the  appearance,  observable  in 
cases  of  extensive  cirrhosis,  of  sharply  marked- 
off  small  islands  of  liver  tissue,  many  of  them  of 
pale  yellow  color  standing  out  sharply  from 
the  surrounding  tissue.  In  addition  there 
were  the  larger  yet  paler  nodes  of  cancer.  On 
microscopical  examination  the  extensive  cir- 
rhotic change  of  monolobular  type  was  well 
observed.  The  nodes  or  masses  of  new 
growth  were  sharply  encapsulated.  He  felt 
some  hesitation  hi  describing  them  as  fully 
developed  carcinoma,  for  there  was  a  tendency 
to  preserve  the  type  of  liver  tissue.  In  parts 
the  cells  tended  to  be  arranged  in  columns 
resembling  the  relationship  in  the  lobules  of 
liver  tissue,  and  judging  from  the  amount  of 
bile  pigment  deposited  in  some  of  them  (as  in 
cells  of  the  surrounding  functional  tissue)  they 
were  not  so  far  removed  from  the  normal  as  to 
have  lost  all  specific  action.  Again,  the 
growths  were  not  infiltrating,  but  were  sharply 
defined  and  encapsulated.  But  in  general  the 
evidence  of  regular  gr'^wih  had  been  lost  and 
the  cells  were  massed  together  without  regular 
order,  while  degenerative  processes  had 
affected  the  centres  of  many  of  the  masses. 
Perhaps  the  term  adenocarcinoma  would 
express  this  transition  from  simple  to  cancer- 
ous overgrowth.  Frequently  in  cases  of  pri- 
mary growths  in  the  liver  this  difficulty  is  met 
with.  Sections  taken  from  the  left  lobe  showed 
nodules  of  overgrowth,  rare  and  small  com- 
pared with  those  in  the  right.  Here  the  cir- 
rhosis was  extreme.  Dr.  Adami  compared 
this  development  of  multiple  overgrowths  of 
gland  tissue  in  the  ciirhotic  liver  to  the  more 
frequent  development  of  adenomata  in  the 
cirrhosed  kidney.  In  both  organs  there 
occurred  a  cutting  off  of  portions  of  the  gland 
by  bands  of  interstitial  fibrous  tissue  followed 
by  proliferation  of  the  gland  tissue  and  the 
development  ol  adenoid  neoplasms. 

Thus  microscopical  examination  fully  con- 
firmed the  conclusions  arrived  at  by  Dr. 
Finley  in  his  study  of  the  case  during  life,  and 
explained  the  clinical  history  which  he  (Dr. 
Adami)  had  heard  that  evening  for  the  first 
time. 

On  Two  Diffcretit  Conditions,  of  the  ^fit}al 
Valve  giving  rise  to  Pre  systolic  Mt/nnnr. —  Dr. 
Adami  exhibited  two  hearts.  The  first  case 
was  one  of  mitral  stenosis  from  a  patient  in  Dr. 
Stewart's  wards  at  the  Royal  Victoria  Hospital. 
The  patient  gave  the  frequent  history  obtain- 
able in  cases  of  mitral  disease,  namely,  that  of 
attacks  of  acute  rheumatism.  Here  there  had 
been  an  attack  fifteen  years  ago  and  another  in 
January,  1892.  There  had  been  a  premature 
labor  at  the  eighth  month  six  years  ago,  with 
evidences  of  albuminuria  and  dropsy.  From 
this  There  had  been  only  partial  recovery,  the 
slightest  cold  sufficing  to  bring  on  swelling  anew 
in  the  lower   extremities.     In  August  last  pul- 


THE  CANADA  MEDICAL  RECORD. 


23t 


nionary  trouble  supervened  and  cedema  became 
constant.  There  was  dyspnoea  and  profuse 
expectoration.  The  condition  became  more 
severe,  and  the  patient  was  admitted  into  hos- 
pital upon  January  6th. 

On  admission,  not  to  enter  into  full  details, 
the  pulse  was  of  fair  tension  and  regular,  the 
arteries  felt  a  little  sclerosed.  There  was  a 
diffuse  impulse  in  the  fourth  and  fifth  spaces, 
and  a  strong  impulse  was  felt  in  the  fifth  inter- 
space at  the  nipple  line.  First  sound  rather 
muftled,  second  fairly  clear.  Both  systolic  and 
presystolic  murmurs  were  heard  traceable 
towards  the  axillary  line,  with  a  diastolic  blow- 
ing murmur  at  the  apex,  heard,  however,  much 
better  along  the  left  border  of  the  lower  half  of 
sternum.  As  the  autopsy  showed,  this  murmur 
probably  originated  in  the  right  heart. 

The  heart  was  of  great  size,  450  grm.,  right 
auricle  greatly  distended,  passing  well  (4  cm.  ) 
over  the  middle  line.  The  distended  right  ven- 
tricle formed  the  whole  anterior  surface  of  the 
heart  below  and  to  the  left,  the  left  ventricle 
being  completely  out  of  sight,  and  the  apex  lying 
close  upon  the  seventh  rib  in  the  anterior  axil- 
lary line.  Evidently,  therefore,  the  impulse  felt 
during  life  in  the  fifth  interspace  at  the  nipple 
line  must  have  been  due  to  the  systole  of  the 
right  ventricle. 

There  was,  as  the  specimen  showed,  extreme 
stenosis  of  the  mitral  valve  with  thickening  and 
sclerosis  of  the  aortic  valve?,  but  by  the  usual 
test  these  last  showed  themselves  still  compe 
tent. 

The  stenosis  of  the  mitral  was  so  extreme  that 
the  slit-like  opening  was  only  one  centimetre  in 
length.  'J'he  valves  were  markedly  fibroid. 
The  aorta  showed  patches  of  atheromatous  de- 
generation that  had  not  passed  the  fatty  stage, 
most  frequent  in  the  abdominal  region.  The 
patient  was  only  36  years  old. 

The  second  heart  was  from  a  youth  of  16 
years  of  age,  also  an  occupant  of  Dr.  Stewart's 
ward.  In  this  case  the  history  was  more  especi- 
ally one  of  chorea.  There  was  one  attack  at 
the  age  of  seven  which  lasted  for  two  years,  an- 
other of  a  month's  duration  when  he  was  twelve. 
The  only  rather  doubtful  indication  of  acute 
rheumatism  obtainable  was  that  the  last  illness 
began  in  May,  1894,  with  pain  and  stiffness  in 
the  joints  and  marked  swelling  of  the  finger 
joints  lasting  for  one  day  ;  with  this  there  was 
shortness  of  breath,  which  steadily  became  ac- 
centuated. 

On  admission  on  January  22nd  the  patient 
was  extremely  anaemic,  poorly  nourished  and 
feeble.  The  cardiac  impulse  raised  the  whole 
side  of  the  chest,  extending  for  five  inches  from 
the  third  to  the  seventh  ribs.  The  apex  was 
recognizable  at  the  seventh  rib,  four  and  a 
quarter  inches  from  the  mid-sternal  line.  There 
was  a  roughish  systolic  murmur  at  the  apex 
heard  all  over  the  anterior  aspect  of  the  chest  ^ 


and  back.  At  the  back  it  could  be  heard  as  low 
as  the  line  joining  the  crests  of  the  ilia.  At  the 
fifth  space  there  was  a  rough  presystolic  murmur 
not  transmitted.  Presystolic  thrill  plainly  felt 
at  the  level  of  the  fourth  rib. 

On  opening  the  chest  the  heart  was  fnund  to 
extend  5.5  cm.  to  right  of  median  line  and  10 
cm.  (four  inches)  to  the  left.  The  apex  in  the 
sixth  interspace.  The  right  auricle  was  greatly 
distended.  The  anterior  aspect  of  the  ventricu- 
lar region  was  formed  about  equally  of  right  and 
left  hearts.  Left  auricle  fairly  flaccid,  but  had 
evidently  undergone  so  much  previous  disten- 
sion that  the  auriculo-ventricular  groove  was  al- 
most e.vadicated  and  the  walls  almost  parchment- 
like and  fibroid  rather  than  muscular,  the  ap- 
pendix appearing  not  so  much  as  a  prolongation, 
but  as  a  diverticulum  off  at  right  angles  to  the 
auricular  cavity.  With  this  the  mitral  orifice 
was  found  much  larger  than  normal.  In  the 
adult  this  orifice  should  admit  roughly  three 
fingers  ;  here  in  a  boy  of  sixteen  it  admitted  five, 
and  was  M.75  cm.  in  circumference  at  the  nar- 
rowest part.  The  valve  flaps  were  moderately 
sclerosed  with  veiy  slight  roughening  and  vege- 
tation. 'J"he  chordre  tendinese  were  thickened, 
the  papillary  muscles  large  and  fibroid  at  their 
apices.  The  left  ventricle  presented  extreme 
dilatauon. 

The  aortic  cups  showed  small  wreaths  of  old 
vegetations  below  the  line  of  apposition.  They 
were,  however,  quite  competent.  Thus  this 
case  differed  from  those  of  Dr.  Austin  Flint. 
{Lancet,  ]a.r\.  27th,  1883.)  The  right  heart 
presented  no  great  abnormality.  Contrary  to 
what  was  the  case  in  the  previous  heart,  here 
the  tricuspid  orifice  was  above  the  normal 
capacity. 

Commenting  on  the  cases  Dr.  Adami  said  : 
"  In  these  two  hearts,  apart  from  other  points 
of  interest,  we  have  the  history  of  well-marked 
presystolic  murmur  associated  with  the  diam- 
etrically opposite  conditions  of  extreme  stenosis 
and  of  dilatation  of  the  mitral  orifice.  In  the 
one  ease  the  stream  of  blood  pouring  through 
from  the  left  auricle  into  the  ventricle  at  the  end 
of  ventricular  diastole  must  have  been  peculiarly 
fine  and  have  passed  through  with  considerable 
force  ;  in  the  other  there  must  have  been  a  large 
stream  passing  slowly.  In  the  former  the  wall 
of  the  auricle  was  distinctly  of  a  muscular  type  ; 
in  the  latter  the  muscle  was  thinned  and  weak- 
ened. The  edges  of  the  mitral  orifice  in  the 
case  of  stenosis  were  smooth,  in  that  of  the  dil- 
atation were  slightly  roughened. 

"  These  two  cases  then,  so  far  as  they  go, 
show  that  the  presystolic  muimur  is  not  depend- 
ent upon  the  absolute  size  of  the  orifice,  and  I 
would  go  so  far  as  to  say  that  with  such  ex- 
tremes it  cannot  be  dependent  even  on  the  re- 
lative size.  They  show  also  that  the  condition 
of  the  edges  of  the  orifice,  through  which  the 
stream  of  blood  pours,  must  only  play  a  second- 


232 


THE  CANADA   MEDICAL   RECORD. 


ary  part ;  and,  in  short,  if  we  accept  ihe  view 
that  thepresystoh'c  murmur  is  auricular  systolic, 
due  to  the  pouring  of  l)lood  into  the  ventricle  in 
consequence  of  the  contractions  of  the  auricle, 
they  make  it  extremely  difficult  to  assign  a 
cau^e  for  its  development.  The  one  point  in 
cummon  in  the  two  cases  is  disease  of  the 
miiral  valve.  That,  so  far  as  I  can  see,  is  the 
on'y  common  ground." 


i3ro0rc6S    ot    ^cience 


PERSISrENr  URETHR.\L   DIS- 
CHARGES DUE  TO  SEMINAL  VESI- 
CULITIS. 

Dr.  Eugene  Fuller,  in  a  study  of  the  subject 
of  persistent  urethral  discharge^  advances  the 
following  conclusions  : — 

1.  Seminal  vesiculitis  is  tiie  cause  of  chronic 
urethral  discharges  in  a  certain  percentage  of 
cases. 

2.  In  about  one-third  of  these  cases  the 
seminal  vesiculitis  is  tubercular  in  character. 

3.  It  is  most  important  to  differentiate  be- 
tween the  simple  inflammatory  and  the  tubercu- 
lar cases,  owing  to  the  difference  in  prognosis 
and  treatment. 

4.  In  the  sim;jle  inflammatory  ca«es  the 
prognosis  is  good  unless  the  subject  is  of  an 
advanced  age,  the  duration  of  the  treatment 
depending  largely  on  the  chronicity  of  the 
case. 

5.  The  treatment  emi^loyed  in  these  simple 
cases  consists  of  stripping  the  vesicles,  thereby 
squeezing  out  into  the  utethra  their  inflamma- 
tory contents  by  means  of  the  forefinger  in- 
troduced into  the  rectum.  This  treatment 
should  be  employed  once  in  five  to  seven  days, 
a  long  interval  bring  alK-wed  to  elapse  between 
treatments  should  signs  of  acute  inflammation 
appear  as  a  result  of  the  manipulations. 

6.  The  duration  of  the  treatment  may  be  all 
th.e  way  from  a  month  or  six  weeks  in  subacute 
cases  to  many  months,  and  possibly  a  year,  in 
very  chronic  ones. 

7.  At  the  commencement  of  treatment  tlie 
parts  are  usually  very  tender,  indurated,  and 
distended.  If  the  rase  progress  favorably,  all 
these  elements  giadually  diminish,  and  finally 
disappear  as  resolution  takes  i)lace.  The  dis- 
charge customarily  wholly  disappears  btfore  a 
cure  in  the  vesicles  is  attained. 

8.  in  tubercular  cases  the  teiulerncss  in 
connection  with  the  vesicles  is  not  liable  to  be 
so  great  as,  and  the  induration  more  than,  in 
simple  inflammations.  In  tiiis  form  of  inflam- 
mation the  pans  resent  the  manipulations,  un- 
less,   indeed,   they  be    most  gentle,   and  even 


then  it  is  a  question  if  this  form  of  treatment  is 
beneficial.  If  the  tubercular  condition  is  not 
diagnosed  at  first,  the  manner  in  which  the 
vesicles,  when  so  involved,  resent  the  ordinary 
manipul  vtions  by  becoming  more  tender  and 
indurated,  thus  aggra-vating  the  urethral  symp- 
toms,   speedily   renders    the  correct    diagnosis 

!  apparent. 

(  9.  Many  of  these  tubercular  cases  become 
quiescent  under  internal  medication  and 
hygienic  measures. — Journal  of  Cutaneous 
and  Gen  if  0- Urinary  Diseases. 


THE   TREATMENT  OF  .STRICrUREOF 
THE  CESOPHAGUS. 

After  an  exhaustive  discussion  of  the  various 
operative  procedures  in  oesophageal  stricture, 
Dr.  Willy  Meyer  arrives  at  the  following  con- 
clusions : 

1.  There  are  now  three  useful  and  reliable 
methods  of  gastrostomy  at  the  surgeon's  dis- 
posal. Of  these,  one  (Wit/.el's)  prevents  leak- 
age with  absolute  certainly.  The  two  others, 
if  properly  carried  out,  pro.uise  the  same  good 
result.  Thus  the  pa.ient  who  had  been  sub- 
mitted to  this  opeiation  will  not  starve  from 
regurgitation  of  the  food  alongside  the  tube. 

2.  In  view  of  this  fact,  gastrostomy  should 
be  resorted  to  "  early  "  in  cases  that  will 
sooner  or  later  need  this  operation. 

?.  In  cases  of  burn  of  the  oesophagus,  pri- 
mary gastrostomy  and  litiiely  dilatation  of  the 
contracting  scar  will  most  probably  prevent 
conditions  which  at  present  generally  c  jnfron*. 
the  surgeon  in  this  class  of  cases,  and  are 
sometimes  incurable.  Witzel's  method  of  gas- 
trostomy deserves  preference.  The  oblique 
canal  produced  by  it  will  close  spontaneously 
when  the  tube  has  been  removed.  Tims  a 
secondary  operation    will  not  be  needed. 

4.  In  cases  of  cancer  of  the  oesophagus  a 
gastric  fistula  should  be  established  as  soon  as 
the  scales  show  a  steady  decrease  of  the  pa- 
tient's weight. 

5.  Further  experience  is  needed  with  refer- 
ence to  Ssabanejew-Frank's  method  before  an 
attempt  can  be  made  at  giving  each  oftlie  three 
operati(Mis  I'.s  proper  ];lace  in  the  treatment  of 
cancerous  stenosis.  If  future  observations  be 
favorable,  Ssabanejew-Frank's  operation  seems 
to  be  destined  to  become  the  standard  one  for 
mah'gnant  stricture  of  the  oesophagus.  If 
unfavorable,  Witzel's  method  should  be  done 
wherever  it  can  be  carried  out. 

6.  Von  Hacker's  method  should  then  be 
reserved  for  far-gone  cases,  and  should,  if  the 
patient  be  very  weak,  be  done  under  cocaine- 
anir;>thesi,i,  best  at  two  sittings.  If  properly 
performed  the  outlook  for  making  the  fistula 
clo.e  tightly  around  the  tube  is  good. — Amer . 
/our.  0/  Mei/.  Seienees,  October,  1S94. 


THE   CANADA   MEDICAL   RECORD. 


233 


A  NEW  OPERATION  FOR  THE  RADICAL 
CURE  OF    HERNIA. 

The  operation  devised  by  Dr.  C.  A.  L.  Reed 
is  as  follows  :  Incision  in  inguinal  hernia  is 
made  from  a  point  two  inches  above  Poupart's 
ligament,  midway  between  the  anterior  supe- 
rior spinous  process  of  the  ileum  and  the  spine 
of  the  pubes,  oblique  downward  and  inward  as 
nearly  as  possible  consistent  with  the  access  of 
the  inguinal  canal  to  a  point  at  the  base  of  the 
scrotum.  The  dissection  is  then  carried  into 
both  scrotal  and  pelvic  cavities.  The  protrud- 
ing viscera  are  then  reduced  and  carefully  in- 
sp.xted after  being  brought  out  above.  The  sac 
is  then  carefully  dissected  from  its  scrotal  con- 
nections, and  reversed  by  invagination.  It  is 
then  opened  by  two  incisions  :  one  toward 
the  pubes,  the  other  toward  the  ileum,  being 
thus  converted  into  an  anterior  and  a  posterior 
flap.  The  cord  is  now  dissected  loose  and 
placed  in  the  canal  and  denuded  of  its  perito- 
neum at  its  outer  angle.  The  internal  ring  is 
closed  by  several  interrupted  sutures,  animal 
or  buried  silk,  these  sutures  being  applied  be- 
neath the  peritoneal  flaps  formed  by  splitting 
the  sac,  care  being  taken  that  in  the  closure  of 

'the  ring  undue  pressure  shall  not  be  brought  to 
bear  upon  the  cord.  The  posterior  peritoneal 
flap  is  now  excised,  the  stump  being  ligated 
should  there  be  any  necessity  for  doing  so. 
The  anterior  flap  is  carried  across  the  now 
obliterated  internal  ring,  and  stitched  by  inter- 
rupted sutures  to  the  posterior  parietal   perito- 

'neum.  The  external  ring  is  now  closed  by 
passing  a  number  of  sutures  through  its  pillars 
external  to  the  cord,  which  is  now  fixed  in  the 
internal  (pubic)  angle  of  the  outlet  of  the 
canal.  The  incision  into  the  abdomen  is  clos- 
ed by  an  interrupted  figure  of  eight  suture,  the 
internal  loop  embracing  the  peritoneum,  the 
aponeurosis  of  the  transversalis  and  of  both 
oblique  muscles,  and  the  external  loop  embra- 
cing the  superficial  fasciae,  fat  and  skin.  These 
sutures  should  not  be  more  than  three-quarters 
of  an  inch  apart.  The  incision  into  the  scro- 
tum may  be  closed  in  the  ordinary  way.  Drain- 
age should  not  be  employed  except  in  the 
presence  of  marked  oozing  or  obvious  infection. 
— Jour.  Anier.  Med.  Assoc. 

A  NEW  METHOD  OF  SHORTENING 
THE    TENDO    ACHILLIS. 

Phocas  {Amer.  Med.  Sur^.  Bulletin')  pro- 
poses the  following  operations  : 

A  median  incision  five  or  six  centimeters  is 
made,  over  the  tendon  the  sheath  opened,  and 
the  tendon  carefully  denuded.  It  is  then  trans- 
fixed laterally  at  the  upper  end  ofthe  wound  by  a 
bistoury  which  is  carried  down  the  middle  of  the 
tendon  by  a  sawing  motion.  The  posterior  flap 
is  cut  away  above  and  below.  The  anterior  part 
of  the  tendon   is  thin  enough  to  be  folded  on 


itself,  and  this  is  now  done,  the  freshened 
surfaces  together,  thus  shortening  it  one-half 
the  length  of  the  incision,  and  the  fold 
stitched  together  with  cat-gut.  The  sheath  is 
closed,  and  the  skin  also,  separately.  The  foot 
is  then  put  up  in  equinus  in  a  fixed  dressing. 

DIAGNOSIS    AND    TREATMENT    OF 
APPENDICITIS. 

M.  Monod  discussed  this  subject,"  Treatment 
of  Appendicitis,"  at  the  Eighth  Congress  of, 
French  Surgeons,  held  at  Lyons,  October  9-13, 
■i2>g^{Allgemeine  Medicinischc  Central Zeitung, 
No.  102).  In  all  his  22  cases  surgical  inter- 
ference was  resorted  to,  with  brilliant  results  if 
done  early.  Five  out  of  his  22  operative  pa- 
tients died  ;  in  all  cases  pus  was  found  in  the  ab- 
dominal cavity.  The  diagnosis  should  be  made 
early,  even  before  a  tumor  appears.  The  diag- 
nostic points  are  :  The  sudden  appearance  of 
:he  symptoms  ;  the  retraction  ofthe  abdominal 
walls  ;  and  the  spontaneous  and  violent  pain, in- 
creased by  the  slightest  external  pressure.  The 
afebrile  course  of  some  cases  is  noteworthy. 
The  incision  should  be  very  similar  to  the  one 
employed  for  ligation  of  the  iliac  artery.  The 
appendix,  if  found,  is  to  be  exsected  ;  otherwise, 
the  entire  disease  area  is  to  be  cleaned  out,  and 
drainage,  not  suture,  employed.  The  techni- 
que is  simple  ;  and  the  operation  should  be  em- 
ployed in  doubtful  cases  to  clear  the  diagnosis. 

In  the  discussion  M.  Ricard  agreed  with 
Monod  as  to  the  necessity  of  early  operation. 
In  his  16  cases  there  were  4  deaths,  all  due  to 
procrastination  in  operating  from  variou?  causes. 
In  one  of  them  the  appendicitis  ran  a  mild 
course,  and  the  patient  was  apparently  getting 
well  without  interference;  but  a  sudden  move- 
ment in  bed  caused  rupture  of  the  pus  sac,  and 
the  patient  died  36  hours  later  of  general  peri- 
tonitis. Ricard  is  therefore  strongly  in  favor  of 
immediate  operation  as  soon  as  the  symptoms 
of  threatened  perforation  occur. — Intern.  Jour, 
of  Surgery. 

THE    NEATEST  CIRCUMCISION. 

In  a  paper  read  at  the  last  meeting  of  the  Miss 
Valley  Med.  Assoc,  Dr.  Bransford  Lewis,  of  St. 
Louis, detailed  a  method  of  doing  this  operation, 
for  which  he  claimed  many  advantages  in  celer- 
ity, ease  and  exactitude  of  performance  and 
rapidity  of  healing.  The  operation  was  done 
with  the  assistance  of  two  instruments  presented 
by  the  author,  a  clamp  and  prepuce-tractor, 
which  enabled  the  operator  to  carry  out  the  fol- 
lowing steps  of  procedure  :  i,  after  cleansing 
the  penis  and  encircling  it  with  a  small  rubber 
band,  the  prepuce  is  drawn  strongly  forward, 
the  action  being  applied  to  its  inner  surface 
by  means  of  the  serrated  tractor  mentioned  ;  2, 
the  glans  penis  being  repressed,  the  curved  fen- 
estrated  clamp  is  applied  ;   3,  with  these   as  a 


234 


THE   CANADA    MEDICAL   RECORD. 


support  and  guide,  lo  per  cent,  cocain  solution 
is  injected  between  the  two  layers  of  foreskin, 
anterior  to  the  clamp — no  danger  of  cocain  poi- 
soning occurring,  since  both  clamp  and  rubber 
constrictor  lie  between  it  and  the  general  circu- 
lation ;  4,  after  effective  anaesthesia  has  been  se- 
cured,six  double  length  (ten  inch)  catgut  sutures 
are  run  clear  through  the  clamp-fenestraand  the 
four  layers  of  foreskin  ;  5,  with  strong  scissois 
the  latter  is  cut  off  at  one  sweep  ;  6,  tractor  and 
clamp  being  removed,  the  double  length  sutures 
being  divided,  and  two  additional  sutures  being 
placed  at  the  dorsal  and  frenal  sites,  previously 
occupied  by  the  tractor  ;  7,  the  vessels  are  se- 
cured and  sutures  tied  all  around,  making  a  cir- 
■  cumcision  that  is  at  once  symmetrical,  precise 
and  admirable,  leading  to  prompt  union  and 
a  satisfactory  result. — Joiir-  Amcr.  Med.  Assoc . 

LOCAL  ELECTROLYSIS  AND  ZINC- 
AMALGAM  CATAPHORESIS  IN  MA- 
LIGNANT AND  NON-MALIGNANT 
TUMOR.* 

By  G.  Betton  Masse y,  M.D.,  Physician  to  the 
Gynjecological  Department  of  the  Howard  Hospital, 
etc. 

Before  reporting  the  three  cases  on  which  thi^ 
new  treatment  of  morbid  growths  is  mainly 
based,  I  must  explain  what  I  mean  by  local 
electrolysis  and  zinc-amalgam  cataphoresis,  and 
also  advance  reasons  for  my  belief  that  these 
methods,  either  separately  or  together,  present 
important  advantages  over  cutting  operations 
in  certain  cases  of  benign  vascular  growths  and 
incipient   cancers. 

Local  electrolysis  means  simply  that  the  elec- 
trical decomposition  of  the  tissue  salts  is  confined 
to  a  localized  area  by  the  approximation  of  ths 
poles.  If  both  poles  of  a  galvanic  current  be 
placed  in  the  morbid  tissue,  quite  near  each 
other,  the  bulk  of  the  current  will  be  concen- 
trated within  the  portion  of  tissue  immediately 
between  them,  and  but  little  will  traverse  the  out- 
side healthy  parts.  In  practice  they  should  not 
be  further  apart  than  from  a  half  to  one  inch, 
though  this  depends  entirely  on  the  strength  of 
qurrent  to  be  used  and  the  size  of  the  growth. 
So  placed,  an  enormous  current  may  be  em- 
ployed to  dissolve  a  morbid  tissue  without  af- 
fecting surrounding  tissues,  the  parts  having 
been  chilled  by  a  spray,  or  otherwise  rendered 
anaesthetic,  if  sensitive.  The  surgical  possibil- 
ities of  such  currents  are  quite  remarkable. 
All  the  salts  and  liquids  of  a  given  growth  lying 
between  the  points  become  a  prey  to  such  .a 
current,  the  watery  contents  being  turned  into 
oxygen  and  hydrogen  gases,  and  the  complex 
salts  into  solutions  of  acids  and  alkalies.  This 
is,  of  course,  attended  with  a  material  rise  of 
temperature,  but  nothing  like  charring.     If  the 

*  Read  before  Itie  Philadelphia  County  Medical  Society,  Jan. 
9.  '895. 


tissue  subjected  to  the  process  is  soft  and  vascu- 
lar, or  juicy,  there  will  be  very  little  left  be- 
tween the  poles  after  the  gas  has  been  given  off. 
but  the  acids  and  alkaloids  dissolved  in  a  turbid 
liquid  remainder.  Jf  the  tissue  is  tougher 
and  more  fibrous,  a  gristly  residue  will  be 
found  which  can  be  detached  or  left  to  be  de- 
tached by  nature. 

The  strength  of  current  required  to  destroy 
tissue  in  this  way  depends  altogether  on  its  con- 
centration at  the  active  spot.  A  minute  repro- 
duction of  the  process  occurs  when  we  apply  but 
two  or  three  milliamperes  to  the  papilla  of  a 
hair  sheath,  or  to  a  mole  on  the  skin  ;  but  to 
completely  dissolve  tissues  between  two  or  more 
needles  a  half  inch  apart  requires  at  least  four 
hundred  to  seven  hundred  milliamperes. 

Whether  this  portion  of  my  method  has  any 
advantages  over  a  cutting  operation  in  remov- 
ing malignant  or  non-malignant  external  growth 
depends  upon  circumstances.  It  is  clearly  in- 
applicable to  any  growth  within  the  body,  un- 
less it  is  situated  in  a  drainable  natural  cavity, 
as  a  considerable  quantity  of  detritus  must  drain 
away.  It  also  presents  the  disadvantage  of  not 
permitting  healthy  tissues  to  be  united  at  once 
over  the  seat  of  the  removed  growth,  a  proce- 
dure, however,  that  is  often  of  doubtful  utility, 
as  it  frequently  covers  up  portions  of  the  dis- 
ease that  failed  lo  be  removed.  The  advan- 
tages of  the  method  over  the  knife  are,  on  the 
other  hand,  by  no  means  inconsiderable.  It  is 
absolutely  bloodless,  no  matter  where  applied, 
thus  enormously  conserving  strength  after  op- 
erations notoriously  bloody  ;  the  edges  of  the 
undestroyed  tissue  remain  non-absorbent,  ks- 
sening  risk  of  sepsis  ;  and  finally  there  seems  to 
be  some  proj)erty  in  the  galvanic  current  to 
cause  a  retrogression  of  the  whole  of  a  benign 
growth  even  when  but  a  portion  is  directly  act- 
ed on,  as  in  the  Apostoli  treatment  of  fibroids 
and  the  ordinary  treatment  of  moles  and  other 
small  skin   tumors. 

If  the  growth  be  a  benign  one,  the  application 
described  will  probably  cover  the  whole  of  the 
active  treatment.  If  it  be  malignant,  on  the 
contrary,  the  second  i)ortion  of  the  method — 
zinc-amalgam  cataphoresis — is  employed,  a  pro- 
cedure of  great  value  in  radically  removing 
all  remaining  traces  of  a  still  localized  cancerous 
growth. 

Zinc-amalgam  rataphoresis  is  electrically 
monopolar,  the  single  active  electrode,  which  is 
always  positive,  being  ap]ilied  to  the  cavity  left 
by  removal  of  the  greater  portion  ofthe  growth, 
while  the  indifferent  or  negative  electrode,  in 
the  shape  of  large  conducting  pads  connected  to- 
gether, is  j)laced  un  any  convenient  portion  of 
tlie  body.  The  active  electrode  is  a  freely-amal- 
gamated zinc  surface  of  one  or  two  square  cen- 
timetres area,  which  is  held  successively  against 
all  portions  of  the  bottom  and  edge  of  the  ex- 
cavation.    From  150  to    300  milliamperes  are 


THE   CANADA   MEDICAL   RECORD. 


235 


sufficient,  the  pain  being  controlled  by  cocaine 
in  solution  placed  in  the  excavation  beneath  the 
electrode  to  be  conveyed  into  the  tissues  simul- 
taneously with  the  nascent  oxychloride  of  zinc 
and  mercury  which  is  dissolved  from  the  elec- 
trode I)y  electrolysis. 

By  this  procedure  we  search  out  and  destroy 
all  remaining  spurs  and  paths  of  infection  in 
the  contiguous  unhealthy  and  healthy  tissues, 
the  current  seeking  vascular  and  cellular  paths 
of  less  resistance  by  preference  in  its  journey 
to  the  other  pole  ;  and  to  the  lethal  effect  of  the 
current  we  add  the  well-known  lethal  effects 
of  nascent  mercury  and  zinc  compounds.  The 
surface  of  the  amalgamated  zinc  electrode  is 
consumed  in  the  process — the  mercury  as  well 
as  the  zinc — producing  a  mixed  infiltration  of 
the  immediate  polar  region  that  is  readily  de- 
tected by  the  eye.  Low  organisms  m  the  im- 
mediate neighborhood  of  the  electrode  quickly 
succumb,  and  the  antiseptic  value  of  the  pro- 
cedure is  shown  in  the  correction  of  any  odors 
that  may  have  accompanied  the  cancerous  dis- 
charge. That  the  action  is  not  confined  to  the 
immediate  neighborhood  of  the  electrode  was 
well  demonstrated  in  one  case  in  which  the  zone- 
like base  of  a  cancer  was  observed  to  lose  its 
induration,  and  shrink  in  places  at  least  an  inch 
distant  from  the  contact  point.  The  applicabil- 
ityofthe  first  portion  of  the  method — local 
electrolysis — to  a  benign  growth  was  shown  in 
the  case  of  a  large  intra-uterine  cystic  fibroid, 
which  was  destroyed  piecemeal  by  repeated 
applications  of  bipolar  local  electrolysis,  result- 
ing in  a  satisfactory  cure  ;  and  two  other  cases 
were  reported  ;  one  of  sarcoma  of  tonsil  and  soft 
])alate  cured  by  electrolysis,  followed  by  zinc- 
amalgam  cataphoresis,  was  also  referred  to  me 
by  Dr.  Hemminger,  February  17,  1893.  Five 
years  before,  he  suffered  from  an  abscess  of  the 
ear.  Two  years  before  being  seen  by  me  the 
left  tonsil  was  found  to  be  the  seat  of  a  tumor. 
He  had  recently  been  sent  to  the  Hospital  of 
the  University  of  Pennsylvania,  where,  he  says, 
mahgnancy  was  diagnosed  and  an  operation 
was  proposed,  which  he  declined. 

A  tumor  about  the  size  of  a  goose  egg  filled 
the  pharynx,  involving  the  tonsil  and  soft  palate 
and  threatening  suffocation.  Liquids  could  be, 
swallowed  with  much   difficulty. 

The  patient  was  placed  on  monopolar  nega- 
tive punctures,  30  to  60  milliaraperes,  daily. 
But  little  progress  being  apparent  at  the  end  of 
a  week,  the  parts  were  cocainized  and  subject- 
ed to  bipolar  local  electrolysis  with  from  200  to 
350  milliamperes,  on  two  occasions.  The  sep- 
aration of  the  eschar  that  resulted  was  accom- 
panied by  considerable  pain  and  reaction,  but 
as  the  place  healed  it  was  found  that  but  little 
of  the  tumor  remained.  He  did  not  return  for 
further  treatment  until  more  than  a  year  had 
elapsed,  during  which  he  seemed  to  be  wfell. 
At  this  time,  however,  a  renewal  of  the  growth 


occurred,  and  it  was  about  the  size  of  a  peach- 
stone  when  he  was  re-admitted  to  the  Howard 
Hospital  for  further  treatment.  During  this 
second  treatment  zinc-amalgam  cataphoresis 
was  mainly  employed,  the  tr-eatment  lasting  six 
weeks  and  being  carried  deeply  into  the  base  of 
the  growth.  A  complete  cure  resulted,  and  at 
an  examination  of  the  parts  six  months  later  a 
healthy  scar  only  was  to  be  seen  ;  the  other,  an 
inoperable  carcinoma  of  the  groin  greatly  reliev- 
ed by  zinc-amalgam  cataphoresis,  resulting  in 
death  from  erosion  of  femoral  artery  and  gan- 
grene. 

An  estimate  of  the  value  of  the  method  in' 
there  three  cases  must  be  comparative,  as  cases 
similar  to  each  are  usually  subjected  to  other 
methods,  removal  with  the  knife  being  the 
favorite.  Hysterectomy  in  the  first  case  would, 
of  course,  have  involved  removal  of  the  ovaries 
also.  Both  this  and  removal  of  the  uterus  itself 
were  avoided  entirely,  no  natural  structures  be- 
ing even  injured,  and  the  time  required  in  the 
treatment  was  probably  not  longer  than  that 
necessary  to  recovery  from  the  effects  of  ab- 
dominal section.  In  the  second  case  the  blood- 
less removal  of  a  sarcoma  of  the  palate  was 
followed  by  a  treatment  that  I  hope  will  render 
the  patient  less  liable  to  a  return  of  the  disease. 
The  third  case  was,  of  course,  a  failure  to 
cure  or  to  preserve  life,  yet  it  is  thought  that 
life  was  prolonged  by  the  very  evident  cur- 
tailment of  the  growth  and  improvement  of 
health.  Comparisons  were  hardly  possible, 
however,  as  an  operation  had  been  refused  by 
one  surgeon  as  useless.- C(?//.  ancl  Clin.  Record 


CLASS  NOTES. 

Carcinomata  of  the  testicles,  oesophagus  or 
tonsils,  according  to  Prof.  Keen,  are  very  rarelv 
benefited  by  operation. 

Prof.  Hare  says  that  Retrocedent  Gout  is  more, 
apt  to  occur  under  the  influence  of  colchicum 
than  in  cases  where  it  is  not  employed. 

Painting  Verruca  with  the  juice  of  the  milk 
weed,  with  tincture  of  iodine  or  with  a  solution 
of  the  perchloride  of  iron,  will  sometimes  cause 
them  to  disappear. 

In  Cirrhosis  of  the  Liver.,  if  ascites  develops, 
the  fluid  should  be  drawn  off  as  often  as  it  ac- 
cumulates. Frequent  aspirations,  Prof.  Hare 
says,  sometimes  cause  a  permanent  cure. 

Prof.  Wilson  says  that  in  children  who  are 
attacked  with  Enteric  Fever  the  symptoms  of 
the  stadium  prodromum  are  of  a  greater  sever- 
ity than  in  adult  life. 

According  to  Prof.  ¥^qqi-\,  Perforating  Ulcers 
0/  the  Foot  result  often  from  a  thickening  of  the 
endoneurium,  with  a  subsequent  compression 
and  destruction  of  the  sensory  nerve-fibres. 


236 


THE  CANADA  MEDICAL  RECORD. 


THE  CANADA  MEDICAL  RECORD 
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ASSISTANT  EDITOR 
ROLLO  CAMPBELL,  CM.,   M.D- 

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MONTREAL,  JULY,  1895. 

THE  ADVANTAGES  OF  PRIVATE 

HOSPITALS. 
We  notice  in  Dr.  Skene's  new  book  on  the 
medical  treatment  of  diseases  of  women,  some 
remarks  on  the  future  progress  of  what  he  calls 
private  hospital  treatment.     He  says  the  order 
and  government  of  such  a  hospital  can  be  made 
agreeable  to  the  suffering    inmates    both  as  re- 
gards  quiet    and    cleanHness,    which  includes 
sewerage  and  ventilation  ;  the  diet  also  can  be 
regulated  according  to  the  laws  of  health,  and 
made  agreeable  and  tempting  to  the  capricious 
appetites  of  patients.     When  the    sole  object 
of  the  establishment  is   to  improve  the  health 
of  those  who    dwell    in   them,  and  where    the 
physician   and  surgeon  and    their  attendants 
have    the   controUing  power,    a  condition    of 
things  is  secured  that  is  almost  impossible  in  a 
private  family.      In  such  an  establishment  the 
doctor  has  great  advantages  ;  his  patients  being 
brought  together,  he  can  attend  a  larger  number 
in  a  shorter  time.     We  might  add  that  he  can 
devote  to  the  patients  the   time  which  would 
otherwise  be  spent  in  useless  driving  about  the 
city  ;  he  has  also  a  more  perfect  control  over  all 
their  doings.     In  this  country  and  in  Europe  we 
find  that  the  foremost  men  among   specialists 
maintain  private  institutions  for  the  care  of  their 
patients.     That  such  institutions  arc  both  suc- 
cessful and  advantageous  to  patients  and  phy- 
sicians   is  a   fact  beyond   all  question.     That 
more  of  them  are  needed  is  also  a  fact.     The 


proof  of  this  is  in  another  fact,  namely,  the 
prosperity  of  institutions  under  the  care  of 
half-educated  men  who  practically  carry  out 
but  one  idea  in  the  treatment  of  diseases,  like 
hydropathic  and  cancer-cure  establishments, 
for  example.  For  many  years  such  places 
have  been  crowded  by  invalids  in  search  of 
health.  Rather  than  waste  energy  in  declaim- 
ing against  such  places,  it  would  be  better  for 
the  profession  to  recognize  the  good  that  is  in 
them,  and  direct  institutions  upon  proper  scien- 
tific principles  to  take  the  place  of  those  which 
have  for  a  long  time  been  the  only  resorts  open 
to  sick  people. 

Coming  from  such  an  authority  as  Professor 
Skene,  this  testimony  in  favor  of  the  private 
hospital  must  be  considered  above  reproach. 


CANADIAN     MEDICAL    ASSOCIATION. 

You  are  invited  to  be  present  at  the  Twenty- 
eighth  annual  meeting  of  the  Canadian  Medical 
Association,  to  be  held  in  Convocation  Hall, 
Queen's  University,  Kingston,  August  28,  29 
and  30,  1895.  Wm.  Bayard,'  President,  St. 
John,  N.B. 

How  TO  GET  THERE. — Purchasc  a  ticket  for 
Kingston  from  the  station  agent  at  the  place  of 
departure,  and  get  from  him  a  standard  certi- 
ficate {which  is  a  receipt  for  one  full  single  fa7-e). 
When  registering  at  the  meeting,  leave  the  certi. 
ficate  with  the  Treasurer  and  it  will  be  returned, 
signed  by  the  Secretary,  on  the  morning  of 
August  30th.  This  certificate  when  presented 
to  the  station  agent  at  Kingston  will  entitle 
the  bearer  to  a  ticket  to  his  destination  (i)  for 
one-third  of  the  single  fare  if  there  are  50  or 
more  holding  standard  certificates,  (2)  free  of 
charge  if  there  are  300  or  more  holding  such 
certificates. 

N.B. —  These  rates    refer  to    delegates    anil 
their  wives. 

Hotel  Accommodation. — Special  per  diem 
rates  :  Frontenac  $2.00  ;  British  American 
$2.00  ;  City  $1.50.  Rooms  may  be  secured 
ahead  by  communicating  with  the  proprietor. 
Memhershit. — The  fee  for  membership  is 
Two  Dollars  ($2.00),  and  may  be  paid  to  the 
Treasurer,  H.  B.  Small  of  Ottawa,  at  the  open- 
ing of  the  meeting. 

Members     of    ihe    profession     desiring    to 
become  members  of  the  Association  may  hand 


THE  CANADA   MEDICAL   RECORD. 


23; 


in  their  names,  with  the  names  of  the  mover 
and  seconder  at  any  time  during  the  meeting, 
to  the  Secretary,  who  will  provide  forms  for 
that  purpose. 

PROVISIONAL  PROGRAMME. 

The  meeting  will  open  at  10  a.m.,  on  Wed- 
nesday, August  28th. 

Addresses  of  welcome  by  the  mayor,  Fife 
Fowler,  and  M.  Sullivan. 

Report  of  Committee  on  Interprovincial  Re- 
gistration during    morning  session  of  first  day. 

The  President's  Address  will  be  delivered  at 
2.30  p.m.  on  the  first  day. 

The  Address  in  Surgery  will  be  given  by  I- 
H.  Cameron,  Toronto,  at  the  evening  session 
on  the  first  day. 

The  Address  in  Medicine  will  be  given  by 
Edward  Farrell,  Halifax,  at  the  evening  session 
on  the  second  day. 

The  Skin  Clinic,  in  which  J.  E.  Graham, 
Toronto,  F.  J.  Shepherd,  Montreal,  an  d  L. 
Duncan  Bulk  ley,  New  York,  will  take  part, 
will  take  place  on  the  evening  of  the  second 
day.  There  will  probably  be  a  C!liiiic  on 
several  nervous  cases  during  the  morning  ses- 
sion of  the  third  day. 

There  will  be  an  excursion  through  the 
Thousand  Islands  by  Steamer  "  America  "  at 
2  p.m.  on  the  2qth  August ;    luncheon  on  board. 

At  4  p.m.  on  August  30th  the  members  will 
visit  the  Penitentiary  and  the  Asylum. 

Papers  will  be  read  in  the  order  in  which 
they  are  received  by  the  Secretary.  [Not  more 
than  30  minutes  will  be  allowed  for  a  paper.) 

1.  Physical  Training  and  Development  as  a 
Therapeutic  Measure. — B.  E,  McKenzie, 
Toronto. 

2.  What  is  the  Best  Treatment  for  Retrover- 
sion of  the  Uterus? — A.  Lapthorn  Smith,  Mon- 
treal. 

3.  A  Tumor  of  the  Medulla  Oblongata. — J. 
E.  Graham,  Toronto. 

4.  Report  on  a  Case  of  Acromegaly. — F. 
Buller,  Montreal. 

5.  Notes  upon  Typhoid  Fever  in  private 
practice. — W.  S.  Muir,  Truro,  N.S. 

6.  Objective  Noises  in  the  Head. — G.  Ster- 
hng  Ryerson,  Toronto. 

7.  Some  Practical  Notes  on  Mental  Depres- 
sion.— J.  V.  Anglin,  Montreal. 

8. — The  Operative  Treatment  of  Injuries  of 
the  Head. — A.  J.  McCosh,  New  York  2 


Discussion  by  James  Bell,  Montreal,  and 
Geo.  A.  Peters,  Toronto. 

9.  Final  results  of  Gastro-Enterostomy. — 
Robt.  C.  Kirkpatrick,  Montreal. 

10.  Dysmenorrhcea,  Report  of  a  Case. — J. 
Campbell,  Seaforth. 

11.  The  Importance  of  Early  Treatment  in 
Cutaneous  Cancers. — A.  R.  Robinson,  New 
York. 

1 2.  The  Anomalies  of  Albuminuria. — Jno.  R. 
Hamilton,  Port  Dover. 

13.  Double  Orchidectomy  in  Enlarged  Pros- 
tate.— E.  E.  King,  Toronto. 

14.  ^Experimental  Cachexia  Strumipriva. — 
Wesley  Mills,  Montreal. 

15.  Notes  on  some  of  the  Newer  Remedies 
used  in  Diseases  of  the  Skin. — L.  Duncan 
Bulkley,  New  York. 

Discussion. 

[6.  Acute  Uraemia,  followed  by  Gangrenous 
Abscess  of  the  Lung. — A.  McPhedran,  Toronto, 

17.  Report  of  a  case  of  Spina  Befida,  with 
treatment. — Jno.  L.  Bray,  Chatham. 

18.  Thyroid  Feeding  in  Cases  of  Stupor. — 
F,  K.  Clark  (Rockwood),   Kingston. 

19.  Syphilitic  Manifestations  in  the  Eye. — 
Alfred  J.  Horsey,  Ottawa. 

20.  The  Ophthalmometer. — R.  A.  Reeve, 
Toronto. 

21. — Notes  on  a  case  of  Brain  Tumor,  with 
an  account  of  its  removal. — J.  Webster,  King- 
ston. 

22.  A  case  of  Placenta  with  Hydatids  :  Foe- 
tus with  Spina  Bifida.— Alex.  Bethune,  Seaforth. 

23.  The  Relation  of  Insanity  to  General 
Diseases. — E.  H.  Stafford,  Toronto. 

24 T.  G.  Roddick,  Montreal. 

25 J.   L.  Currie,  Cambridge, 

Mass. 

26.  Notes  on  a  case  of  Hernia  of  the  Vermi. 
form  Appendix, — R.  W.  Garret,   Kingston. 

27 W.  W.  V/hite,  St.  John,  N.B. 

28.  Some  unusual  Forms  of  Hernia. — F.  J. 
Shepherd,  Montreal. 

29.  Cases  in  Piactice. — W.  G.  Anglin, 
Kingston. 

30.  Operative  Treatment  in  Moveable  Kid- 
ney.— James  Bell,  Montreal. 

31.  Asthma. — H.  J.  Saunders,  Kingston. 
The  above  Programme  is  subject  to  change. 
For   further   particulars,  address,    F.  N.  G. 

Starr,  General  Secretary,  394  Markham  St.^ 
Toronto. 


23^ 


THE   CANADA   MEDICAL   RECORD. 


THE     AMERICAN      ELECTRO-THERA. 
PKUTIC  ASSOCIATION. 

The  fifth  annual  meeting  of  the  American 
Electro-Therapeutic  Association — Dr.  A.  Lap- 
thorn  Smith,  Montreal,  President — will  be  held 
in  "  College  of  Physicians  and  Surgeons  of 
Ontario,"  corner  of  Richmond  and  Bay  Sts., 
ToronlOjOnTuesday, Wednesday  and  Thursday, 
Sept.  3rd,  4th  and  5th,  1895.  ^'o''  ^'^^  conve- 
nience of  those  who  desire  to  attend  also  the 
meeting  of  the  Canada  Medical  Association  in 
Kingston  the  preceding  week,  the  following 
arrangements  i;avebeen  made  with  the  G.T.R. 
and  C.P.R.  A  first  class  full  rate  oneway 
ticket  to  Toronto  should  be  purchased,  and  a 
"  Standard  Certificate  "  to  that  effect  should  be 
procured  from  the  ticket  agent  at  starting  point 
at  time  of  purchasing  ticket,  and  this  must 
be  signed  by  the  Secretary  of  the  Association, 
in  Toronto  in  order  to  secure  reduced  rates  on 
returning.  Holders  of  such  are  entitled  to  slop 
off  at  Kingston  for  Canada  Medical  Association. 
This  applies  to  points  east  of  Kingston.  Infor 
mation  as  to  tickets  from  other  localities  may 
be  obtained  from  Dr.  C.  R.  Dickson,  159  Bloor 
St.  East,  Toronto,  Chairman  of  Committee  of 
Arrangements.  These  privileges  apply  to  all 
who  attend  the  Meeting,  whether  members  or 
not.  A  most  cordial  invitation  is  extended  to 
practitioners.  All  meetings  are  open  to  mem- 
bers of  the  profession.  A  very  interesting  pro- 
gramme will  be  presented,  an  exhibit  of  modern 
electrical  appliances  will  be  held,  and  ample 
entertainment  provided  for. 


SELECTION. 

"The  n'cnnest  n-an  I  know  of  lives  in  Kan 
sas,"  said  a  St.  Louis  i)hysician.  "He  is  a 
farmer,  worth  a  cool  hundred  thousand.  His 
wife  was  taken  suddenly  ill,  and  he  came  to 
town  to  consult  me  about  her  case.  I  told  him 
that  I  could  not  prescribe  intelligently  without 
seeing  the  patient,  but  he  declined  to  incur  the 
expense  of  a  visit.  I  charged  him  $1  for  the 
prescription,  and  he  spent  half  an  hour  trying 
to  beat  me  down  to  90  cents.  He  made  me 
write  the  prescription  in  English,  then  bought 
the  drugs  and  compounded  it  himself  to  save 
the  apothecary's  fee.  One  of  the  ingredients 
was  capsicum.  He  thought  he  had  some  at 
home,  but  was  mistaken,  and  had  to  come 
back  to  town,  a  distance  of  four  miles,  for  it. 
By  this  time  he  had  succeeded  in  saving  about 


20  cents,  and  wasting  $2  worth  of  time,  his 
wife  was  dead  and  the  medicine  a  loss  on  liis 
han  's.  That  so  bore  on  him  that  he  fell  ill. 
He  took  the  medicine  prepared  for  his  wife, 
but  that  only  aggravated  his  malady.  When 
he  finally  recovered  lie  sued  me  for  $10,000, 
and  was  beaten  and  had  to  pay  costs.  He 
then  went  before  the  Grand  Jury  and  tried  to 
have  me  indicted  for  malpractice."  This  man 
is  about  on  a  par  with  the  fellow  who  takes  a 
medical  journal  for  several  years,  and  when 
asked  to  pay  for  it  drops  back  in  the  office 
and  has  it  marked  "refused." — Times  and 
Register. 


CLASS-ROOM  NOTES. 

— Prof.  Longstreth  says  that  Menstruation 
is  usually  interrupted,  or  sometimes  the  flow 
is  delayed,  by  an  oncoming  attack  of  rheuma- 
tism. 

— Prof.  Wilson  says  that  in  cases  of  Enteric 
Fever  sometimes  a  pink  flush,  not  unlike  the 
hectic  flush,  will  develop  •,  it  will  also  be  deeper 
during  the  latter  part  of  the  day. 

— Headache,  often  of  the  most  aggravated 
form.  Prof.  Keen  says,  manifests  itself  in  cases 
of  pressure  on  the  brain  ;  it  is  often  so  severe 
that  the  patient  will  moan  const  mtly. 

— .\s  a  rule.  Prof.  Longstreth  says,  if  a  joint 
swells  very  much  in  a  case  of  Acute  Rhcuma' 
tisin,  fluid  will  be  contained  in  the  joint,  but 
occasionally  it  will  be  found  absent. 

— Prof.  Wilson  says  Urticaria  occasionally 
makes  its  appearance  in  young  people  at  about 
the  time  of  the  crisis  or  during  the  early  part 
of  convalescence  from  typhus  fever. 

— In  cases  of  Uterine  Hemorr/uii^e,  ergot  and 
the  oil  of  erigeron,  Prof.  Hare  says,  are  both 
indicated  ;  the  oil  being  indicated  for  oozing 
and  the  ergot  in  cases  of  more  active  hemor- 
rhage. 


BOOK  NOTICES. 

The  Care  OF  THE  Baby.  A  manual  for  mothers 
and  nurses,  containing  practical  directions 
for  the  management  of  infancy  and  child- 
hood in  hcaltii  and  in  disease.  By  J.  P. 
Crozer  Grifliih,  M.D.,  Clinical  Professor 
of  Diseases  of  Children  in  the  Hospital  of 
the  I'niversity  of  Pennsylvania  ;  Professor 
of  Clinical  Medicine  in  the  Pliiladelphia 
,  Polych"nic  and  School  for  Graduates  in 
Medicine ;  Physician  to  the  Children's 
Hospital,  to  the  Methodist  Episcopal 
Hospital,  and  to  St.  Agnes  Hospital, 
Philadelphia  ;    Member    of  the    American 


THE  CANADA  MEDICAL  RECORD. 


239 


Prediatric  Society  and  of  the  Association 
of    American    Physicians.     Philadelphia  : 
W.  B.  Saunders,  925  Wahnit  Street,  1895. 
Trice  $1.50. 
The  author  has  furnished  a  reliable  guide  for 
mothers    anxious    to  inform    themselves    with 
regard  to  the  best   way  of  caring  for  their  chil- 
dren in  sickness  and  in  health.     There  aie  in 
al)  nearly  400  pages. 

The  first  chapter  of  the  book  discusses  the 
hygiene  of  pregnancy,  the  method  of  calcu- 
lating the  date  of  confinement,  and  similar  data. 
The  characteristics  of  a  healthy  baby  are 
considered  in  the  second  chapter,  and  the 
growth  of  its  mind  and  body  in  the  succeeding 
one.  The  chapters  which  follow  relate  to  the 
methods  of  bathing,  dressing,  and  feeding 
children  of  different  ages,  to  the  hours  for 
sleeping,  to  physical  and  mental  exercise  and 
training,  and  to  the  proper  qualities  of  the 
children's  various  nurses  and  rooms.  A 
special  effort  has  been  made  to  emphasize 
details  and  to  make  them  clear,  complete,  and 
thoroughly  up  to  date. 

The  chapter  upon  the  baby's  diseases  has 
been  written  particularly  for  those  mothers 
who,  through  various  circumstances,  are  un- 
able to  have  a  physician  constantly  within  a 
moment's  call.  It  contains  a  description  of 
the  symptoms  by  which  we  may  know  that 
disease  is  present  ;  a  consideration  of  the 
nursing  of  sick  children  ;  a  concise  resume 
of  the  commonest  diseases  of  infancy  and  child- 
hood ;  and  directions  for  the  management  of 
various  accidents,  including,  among  others, 
drowning  and  the  swallowing  of  poisons. 

The  author's  style  is  so  natural  that  it  is  a 
pleasure  to  take  up  this  book  and  read  a 
chapter  of  it.  It  is  well  indexed,  and  the 
printing,  paper  and  binding  is  a  distinct  im- 
provement on  any  of  this  publisher's  former 
productions ;  in  fact  he  appears  determined  to 
take  the  lead  in  these  departments.  We  con- 
gratulate Dr.  Crozer  Griffith  on  the  admirable 
success  he  has  attained  in  the  production,  and 
trust  that  he  will  not  stop  with  this  interesting 
and  presentable  work. 

Pocket   Formulary   and  Table   of  Doses, 
AND  ALSO  Therapeutics  of  Children's 
Diseases.     By  Dr.  H.  Danchey,  formerly 
Chief  of  Clinic    of  the  Faculty,   formerly 
House  Surgeon  of  the  Children's  Hospital 
and   President  of  the  Medical   Society  of 
the  6th  ward  of  Paris  ;     Laureate    of  the 
Academy    of    Medicine,     Paris.    Socieie 
d'Editions    Scientifiques,  4  Rue   Antcine- 
Dubois,  Paris,  1895. 
This   is  a  handy  little  pocket  volume    thor- 
oughly up  to  date  with  all  the  newer  remedies. 
Le  Moyen-Age  Medical.     Les    medecins  au 
moyen-age.  Les  grandes  epidemics.  Demo- 
nomanie.      Sorcellerie.      Spiritisme.      La 


m^decine  dans  la  litlerature  du  moyen-age. 
Historiens.   Poetts.  Auteurs  dramatiques. 
Par  le  Dr.  Edmond  Dupouy,  Ancien    In- 
terne de  Charenton  etdes  Asiles  d'Alienes, 
Laureat    de    la  Societe  Medico-Psycholo- 
gique.       Prix   Esquirol    et    Prix  Aubanel. 
Paris  :     Societe    d'Editions    Scientifiques, 
Place  de   I'Ecole  de  Medecine,  4,  rue  An- 
toine-Dubois,    1895.  Tons  droits  reserves 
This  is  a   book  of  unusual    merit.     Among, 
the  most  interesting  chapters  is  one  on  the  early 
history  of  the  University  of  Paris.   Another  inter 
esting  chapter  is  that  which  deals  with  thegre 
epidemics    of   Europe.     It    also    shows    that 
women  occupied  an  important  place  in  medicine 
is  the  middle  ages.     The  author  shows  that  he 
IS  a.  man  of  great  learning,  and  must  have  spent 
many  years  in  patient  research  to  produce    the 
volume  of  350  pages. 

Maladies  Internes  et   Maladies    des    En- 

fants.  Par  C.  J.  Smith,  medecin  praticien  a 

Moscou.  Deuxieme  edition.  Paris:  Societe 

d'Editions  Scientifiques,  Place  de  I'Ecole 

de  Medecine,  4  rue  Antoine-Dubois,  1895. 

This  is  a  very  practical    little   volume  of  two 

hundred  pages  in  paper  covers,  and  is  suitable 

for  the  coat   pocket.     It  contains  an  immen  e 

amount  of  information  in  very  condensed  form. 

For  instance,  the  Weir  Mitchell  treatment  with 

diet  table  and  all  only  occupies  two  pages.  The 

price  is  not  stated,  but  we  presume  it  would  be 

about   50  cents. 

Lv  MoRT  apparente   du  Nouveau-ne.     Par 
le  Dr.  Demelin,  chefde  Clinique  d' Accou- 
chement a  la  Faculte  de  Me  Jecine  de  Paris. 
(Memoire    couronne    par  I'Academie   de 
Medecine,  prix  de  I'Hygiene,    1894).     So- 
ciety d'Editions    Scientifiques,  4  rue   An- 
toine  Dubois,  et  Place  de  I'Ecole  de  Mede- 
cine, Paris.     27e  volume  de  la  Petite  Ency- 
clopedic medicale.     Collection  in-i8  raisin 
cartonne  a  3  fr. 
This  is  a  handy  little  volume,  and    contains 
full  directions   for  the    treatment  of  apparently 
still-born  children.     We  notice  that  the  opinion 
of  the    great  American    authority,  Dr.  Lusk  of 
New  York,  is  frequently  quoted. 
La  Prostitution  dans  l'Antiquite,  dans  ses 
rapports     avec    les     maladies     vene- 
riennes.     Etude  d'Hys;iene  Sociale.    Par 
le  Dr.  Edmond    Dupouy,  Ancien   Interne 
de    Charenton    et    des     Asiles  d'Alienes, 
Laureat    de  la    Societe  Medico  Psycholo- 
gique.   Prix  Esquirot  et  Prix  Aubanel.   Un 
vol.  in-S  de    220    pages,    avec  figures,  4 
fr.  Troisieme  Edition.     Socieie  d'Ediiions 
Scientifiques,    4    rue    Antoine-Dubois   et 
Place  de  I'Ecole  de  Medecine,  Paris. 
We  cannot  say   much  in  favor  of  this  work, 
It  were  better  that  it  were  never  written.     We 
must  admit,  however,  that  the  author  has  shown 
an  immense  amount  of  erudition  in  compiling  it, 


240 


THE   CANADA    MEDICAL   RECORD. 


and  he  must  have  had  access  to  many  ancient 
works  which    might    otherwise    be  forgotten. 
This  book  may  do  good  in  one  way,  and  that  is 
by  showing  that,  in   spite  of  all  the  wickedness 
of  ihe  present   day,  it  is  as  nothing  when  com- 
pared with  the  nastiness  and    filthiness  of  the 
manners    and    customs  of  antiquity.     But  we 
would  prefer  to    know  that    such    infamy    was 
buried  and  forgotten  with  the  past. 
La  Cure  de  Bareges.     Le  climat  et  les  eaux 
minerales,      indications     et     contre-indi- 
cations.    Par  le  Docteur  I.  Betous,  Mede- 
cin-Consultant   a    Bareges,  Laureat  de  la 
Faculte   de  Paris,  Membre  de   la  Societe 
d'Hydrologie  medicale,  etc.     Paris  :  Soci- 
6i6     d'Editions     Scientifiqnes,    Place  de 
I'Ecole  de  Medecine,  4   Rue  Antoine-Du- 
bois,   1895. 


PAMPHLETS. 

The  Entr\nce  of  Woman  into  Medicine. 
By  J.  C  Reeve,  M.D.,  Dayton,  Ohio.  The 
Presidential  Address  to  the  Alumni  Asso- 
ciation of  the  Medical  Department  of  the 
Western  Reserve  University,  at  Cleveland, 
Ohio,  delivered  May  22,  1895.  Reprint- 
ed from  Western  Reserve  Medical  Jour- 
nal. 

Burns  of  the  Cornfa  ;  Electric-light  Ex- 
plosion Causing  Temporary  Blindness; 
Traumatic  Injuries  to  Eyes — Hypo- 
pyon. By  L.  Websier  Fox,  M.D.,  Pro- 
f.  ssor  of  Ophthalmology  in  the  Medico- 
Cbiru'gical  College,  Philadelphia,  Penna. 
Clinical  Lecture  delivered  at  the  Medico- 
Chirurgical  College,  March  9,  1895.  Re- 
printedfrom  The  Medical  Bulletin. 

Evisceration  of  Eyep.all.  By  L.  Webster 
Fox,  M.D.,  Philadelphia.  Abstract  of  a 
paper  read  before  the  American  Medical 
Association,  Ophthalmic  Section,  held  in 
Baltimore,  May  7,  1S95.  Reprinted  from 
The  Medical  liulletin. 

An  Electric  Pressure  Sound  for  the  Di 
RECT  Vibration  of  the  Membrana 
Tympani.  By  John  C.  Lester,  A.  M., 
M.D.,  Brooklyn,  Assistant  to  the  Chair  of 
Otology,  ]jellevue  Hosjjital  Medical  Col- 
lege ;  Assistant  Surgeon  to  the  St.  Bartho- 
lotrew's  Clinic  for  the  Eye,  Ear, 'J'hroat, 
and  Nose  ;  ex-1'^ditor  American  Medical 
Digest;  Fellow  of  ihe  American  Academy 
of  Medicine  ;  Member  of  the  Medical 
Society  of  the  County  of  Kings.  Reprint- 
ed from  the  New  York  Medical  Journal 
for  Junes,  1895. 


SuPRA-PuBic  Cystotomy  FOR  Calculus  of  the 
Bladder.  Trendelenburg's  Transverse 
Incision — Transverse  Division  of  the 
Recti  and  Pyramidalis  Muscles — Incision 
of  the  Bladder  without  Inflation  of 
the  Rectum  or  Injection  of  the  Bladder. 
Read  before  the  St  Louis  Medical  Society, 
Dec.  22,  1894.  By  A.  H.  Meisenbach, 
M.D.,  Professor  of  Surgery  in  the  Marion- 
Sims  College  of  Medicine,  St.  Louis,  Mo, 
Reprinted  from  \\\^  Journal  of  the  Ameri- 
can Medical  Association,  March  16, 
1895.  Chicago  :  American  Medical  Asso- 
ciation Press,  1895. 


PUBLISHERS  DEPARTMENT. 

HEMATURIA. 

James  W.  Osboin,  M.D.,  of  Bealton,  Ont.,  Canada, 
writing  to  the  Editor  of  Medical  IVorld,  Philadelphia 
(July  number  1895),  says  :  ''  Regarding  my  obstinate 
case  of  hematuria,  I  told  you  in  a  previous  communici- 
tion  of  my  patient's  restoration  to  a  fair  degree  of  health 
after  a  siege  of  anemia,  emaciation  and  prostration,  but 
that  the  haemorrhage,  though  more  moderate,  was  still 
going  on.  1  have  now  a  still  more  favorable  report  for 
you.  Having  failed  to  obtain  the  tannate  of  foda 
recommended  by  Dr.  Hutchins,  San  Francisco,  from 
my  druggist,  or  in  the  city,  I  ordered  a  bottle  of  San- 
metto,  thinking  by  the  lime  she  had  given  it  a  fair  trial 
I  would  be  able  to  g^  t  the  tannate  0/  soda  elsewhere. 
She  had  only  taken  the  Sanmetlo  a  week,  in  drachm 
doses  three  times  aday,  when  the  hematuriadisappeared. 
This  was  about  three  weeks  ago,  and  it  has  not  returned 
unless  within  a  day  or  two.  This  is  certainly  worthy  of 
note,  as  the  hiiemorrhage,  notwithstanding  her  great 
improvement,  had  never  subsided  entirely  for  more  than 
a  day,  and  that  only  once,  in  a  period  of  about  eiglit 
months.  While  we  cannot  be  sure  of  the  proper  hoc 
from  the  post  hoc,  in  a  single  instance,  it  certainly  looks 
as  if  the  Sanmetto  has  been  of  service  to  the  vis  medica- 
trix  natura?.  I  have  just  received  a  le  ter  from  an  old 
friend  in  the  profession,  who  has  used  Sanmetto  with 
decided  benefit  to  a    patient  afflicted  with    hematuria.'" 


ANTIKAMNIA— QUININE— SALOL. 

The  well-known  therapeutical  properties  of  these 
drugs  makes  this  combination  desirable  in  such  intestinal 
aflections  as  Fermentative  Dyspepsia,  Diarrhiva,  Dysen- 
tery, Duodenal  Catarrh,  Cholera  Infantum,  and  Typhoid 
fever.  Tlie  Antikamnia  controls  the  pain  as  etVectually 
as  morphine,  and  yet  is  never  followed  with  any  of  those 
undesirable  effects  so  characteristic  of  opium  and  its 
derivatives.  Freedom  from  pain  saves  an  immense 
amount  of  wear  and  tear  to  the  system,  and  places  it  in 
a  much  better  position  for  recovery.  The  Salol  acts  as 
an  antiseptic  and  removes  from  the  intestinal  canal  the 
first  or  cnntinuing  cause  of  the  affections  just  mentioned. 
Tiie  ()uiiiine  acts  as  a  tonic,  increasing  the  appetite,  and 
tlius  contributing  much  to  a  speedy  recovery.  Hare 
says  that  (^)uinine  is  not  only  a  simple  bitter,  "  but  also 
seems  to  have  a  direct  effect  in  increasing  the  number  of 
Iht  red  blood  corpuscles."'  A  tablet  composed  of  Anti- 
kamnia two  grains,  Quinine  .'^ulph.two  grains,  and 
Salol  one  grain,  allows  of  the  easy  administration  of 
these  drugs  in  proper  proportionate  doses, 


mnM   MMtd 


Vol.  XXIII, 


MONTREAL,  AUGUST,  1895. 


No.  11. 


ORIGINAL  COMMUNICATIONS. 

llie  Present  Status  of  the  Electrical 
Treatment  of  Fibroi<ls   241 

SOCIETY  PROCEEDINGS. 

JMontreal  Medico-Chirurgical  Soci- 
ety   243 

Discussion  ou  Hypertrophy  of  the 
Heart,  apart  from  Valvular  Dis- 
ease   243 


PROGRESS  OF  SCIENCE- 

Unilateral  Sweating  in  Tuberculosis.  257 


Perinephritic  Abscess.   257 

Treatment  of  Empyema  » 258 

Fistula  in  Ano   ....  258 

Treatment  of  some  Frequent  Mala- 
dies in  Children— Anaemia,  Anie- 
raia  of  Syphilitics,  Foods  Per- 
mitted,   Foods  not     Permitted, 

Nephritic  Colic  258 

Therapeutic  Briefs  —  Prescriptions 
for  Psoriasis,  Chronic  Constipa- 
tion, Blisters  of  the  Feet,  Chronic 
Pharyngitis,  Bronchitic  Asthma, 
In,continence  of  Urine,  Removal 
of  Warts,  Ozjena,  Asthma,  Diph- 
theria, Typhoid  Fever,  Seburr- 
hoeic  Eczema,  Insomnia,  Appen- 
dicitis, Sedative  Plaster,  Psoria- 
sis, Conjunctivitis 259 

Tumor  of  the  Face 261 

Class-Room  Notes  2G1,  264 


EDITORIAL. 

Should  Patients  in  Private  Rooms 
in  Public  Hospitals  be  Allowed 

to  have  their  own  Doctor?    262 

Sanitary  Condition  of  Montreal 2G2 

The  Buffalo  Medical  Journal 263 

A  (Juiet  Resting  Place 2(!:i 

Persoinls   263 

News  Items   264 

Pamphlets  received 204 


Ictgfnal    il'oinmuincattoas. 


THE    PRESENT    STATUS    OF  THE 
ELECTRICAL  TREATMENT  OF 
FIBROIDS.* 
By    a.  Lapthorn   Smith,   B.A.,    M.D., 
Member  of  the  Royal  College  of  Surgeons 
of  England  ;   Fello  w  of  the  Ainer  kan  Gj  - 
ncBcoloi^ical  Society  ;  President  Xnterican 
Electro- Therapeutic  Association;  Snrgeo?i- 
in- Chief  of  the  Samaritan    Hospital  for 
Women,    Montreal ;   Gyncecologist  to   the 
Montreal   Dispensary ;    Surgeon    to  the 
Women's    Hospital,  Montreal. 
The  present  age  in  gynaecology,  and  ab- 
dominal surgery,  especially,  may  be  called 
the  extreme  surgical  age  ;  and,  as  a  result 
of  the  wonderful  advances    and  the    great 
lowering    of  the     death-rate   of    surgical 
operations,  owing  to  the  application  of  the 


*  Abitract  of  paper  read  before  the  section  of  Obste- 
trics and  Gynaecology  of  the  Amprican  Medical  Asso- 
ciation, at  Baltimore,  May  7,  1895. 


principles  of  asepsis,  surgical  enthusiasm  has 
reached  its  highest  point.  One  must  have 
a  great  deal  of  courage,  ndeed,  to  advocate 
any  other  method  of  treatment  than  surgi- 
cal operation,  especially  at  a  meeting  whe.  e 
the  surgical  element  so  greatly  prepon- 
derates; nevertheless,  thewriter  believes  that 
the  majority  of  women  with  fibroid  tumors 
can  be  relieved  of  their  pai;i  and  bleeding 
by  means  of  the  constant  electrical  current. 
If  employed  within  certain  limits,  it  is  abso- 
lutely devoid  of  danger  ;  while  the  appli- 
cation of  the  treatment  should  be  almost 
devoid  of  pain.  On  the  other  hand,  the 
surgical  treatment,  even  under  the  very 
best  of  conditions,  has  so  far  always  been 
accompanied  with  a  mortality  rate  ;  there 
are  fewer  deaths  than  there  were  when 
Freund  lost  seventy-five  per  cent,  of  his 
cases  of  abdominal  hysterectomy,  but  still 
the  death  rate  remains,  so  that  the  electri- 
cal treatment,  with  no  death  rate,  has 
this  great  advantage  over  the  surgical 
treatment.      The  electrical  treatment,  also, 


J42 


THE   CANADA   MEDICAL    RECORD. 


left  the  ovaries  and  the  tubes  in  no  worse 
condition,  but,  on  the  contrary,  in  a  rather 
better  condition  than  they  were  before, 
while  the  surgical  treatment  was  nearly 
always  accompanied  by  the  removal  of  the 
ovaries.  \\'ith  married  women,  and  in- 
deed with  all  women,  the  loss  of  the  ovaries 
was  no  small  affair.  The  temptation  to 
operate  was  very  great.  The  patient's  fate 
was  sealed  one  way  or  the  other,  when  the 
operation  was  concluded,  and,  whether  she 
lived  or  died,  the  surgeon  received  a  great 
deal  of  praise  for  having  the  courage  to  per- 
form the  operation.  Also  the  remunera- 
tion was  sometimes  very  considerable. 
With  the  electrical  treatment,  on  the  con- 
trary, it  was  tedious,  required  sometimes 
as  many  as  fifty  or  one  hundred  applica- 
tion, and  there  were  occasional  relapses. 
This  application  took  up  a  good  deal  of 
time,  but  this  objection  may  be  lessened  by 
devoting  two  afternoons  a  week  exclusive- 
ly to  this  treatment ;  in  which  case  a  con- 
siderable number  of  applications  may  be 
administered  in  a  few  hours,  the  patients 
being  prepared  in  an  adjoining  room,  by  a 
nurse  or  an  assistant. 

The  physician  who  cures  the  patient 
with  electricity  does  not  receive  the  same 
credit  for  his  good  work  as  the  one  who 
cures  her  by  surgical  means,  so  the  temp- 
tation is  very  great  to  operate;  but  he 
could  show  fifty  or  sixty  women  who  had 
been  cured  of  allihcir  symptoms,  and  who 
had  remained  well  since  several  years,  who 
"had  been  treated  by  electricity.  A  great 
many  well-known  gynaecologists  have  used 
the  Apostoli  method  for  fibroids  with 
good  success,  but  have  refrained  from  pub- 
lishing their  cases  for  fear  of  injuring  their 
surgical  reputation.  This  is  a  fact  known 
positively  to  the  writer. 

One  of  the  objections  to  electricity  i\  iiich 
has  been  raised  is  unjust,  and  that  is  that 
it  causes  adhesions.  The  writer  referred 
to  several  cases  which  had  been  cured  of 
their   symptoms,    but    vvcre   subsequently 


operated  on  for  other  reasons,  and  in  which 
no  adhesions  whatever  were  found  after  as 
many  as  one  hundred  strong  applications 
of  the  galvanic  current. 

Another  case  which  he  referred  to 
demonstrated  the  truth  of  Apostoli's  dictum, 
that  when  the  application  of  this  method 
causes  febrile  reaction,  the  tubes  are  badly 
diseased.  In  this  case,  which  had  been 
treated  for  fibroid,  it  had  every  appear- 
ance of  being  one,  could  not  endure  the 
Apostoli  method,  and  was  operated  on  by 
the  writer,  who  then  found  that  the  large 
pear-shaped  mass  in  the  centre  of  the  ab- 
domen was  made  up  of  two  large  sausage- 
shaped  tubes  filled  with  pus,  and  two 
ovaries,  the  size  of  oranges,  and  the  uterus, 
all  glued  together  and  covered  with  lymph. 
These  were  separated  from  each  other  and 
removed,  all  except  the  uterus,  which,  not 
being  much  enlarged,  was  left.  This 
patient  made  a  perfect  recovery.  He  was 
very  much  opposed  to  galVano-puncture, 
which  was,  he  considered,  a  dangerous 
proceeding,  and  he  thought  that  one  could 
obtain  all  the  benefits  required,  by  the 
gentle  use  of  the  positive  pole,  either  in 
the  form  of  platinum,  zinc  or  copper  in  the 
uterus,  which  dried  up  the  bleeding  mucous 
membrane,  and  by  its  tonic  action  upon  the 
muscular  tissue  through  which  the  blood 
vessels  pass  to  supply  the  bleeding  mucous 
membrane  cut  off  the  blood  supply  just  as 
surely  as  though  we  tied  the  ovarian  ar- 
teries. The  action  of  the  electric  current, 
he  said,  as  applied  to  fibroids,  was  three- 
fold. The  first  was  not  mysterious,  but  was 
but  the  arrest  of  circulation  in  the  dilated 
capillaries  by  electro-chemical  cauter}-. 
The  second  is  no  more  difficult  to  under- 
stand than  the  action  of  ergot  or  strychnine  ; 
it  not  only  tones  up  the  vasomotor  system, 
making  the  calibre  of  the  arteries  less,  but 
it  calls  into  play  the  special  and  remark- 
able powers  vvhich  the  uterus  possesses  of 
controlling  its  own  circulation  when  it  has 
the  strength  to  contract. 


THE  CANADA  MEDICAL  RECORD. 


243 


The  third  effect  of  the  current,  its  elec- 
trolytic action,  is,  I  admit,  as  mysterious 
as  it  has  ever  been,  but  not  more  so  than 
the  invariable  absorption  of  syphilitic 
gummatous  deposits  following  the  adminis- 
tration of  iodide  of  potassium.  Whether 
what  we  call  electrolysis  means  the  aclual 
breaking  up  of  an  organic  tissue  into  in- 
organic atoms,  or  whether  it  means,  as 
seems  more  likely  to  me,  that  the  growth 
deprived  of  its  blood  supply  undergoes 
fatty  degeneration,  and  is  partly  eaten  up 
by  phagocytosis  stimulated  to  greater 
activity  by  the  trophic  nerves,  no  one  with 
a  large  experience  with  this  subtle 
fluid  can  deny  that  a  uterus  infiltrated 
with  and  enlarged  by  the  deposit  of 
fibrous  tissue,  whether  localized  in  the 
form  of  fibroids  or  diflused  as  in  areolar  hy- 
perplasia, so  that  the  sound  will  enter  four 
or  five  inches,  will  invariably  diminish  in 
depth  by  means  of  electrical  treatment. 

Then,  again,  what  is  the  enormously  en- 
larged uterus  after  delivery  but  a  bleeding 
myoma  ?  Does  it  not  stop  bleeding  when 
the  arteries  which  supply  it  with  blood  are 
squeezed  by  its  contracting  walls  ?  Does 
it  not  rapidly  get  smaller  when,  foi"  the 
want  of  blood  and  exercise,  that  immense 
mass  of  muscular  tissue  silently  undergoes 
fatty  degeneration  and  returns  to  the  blood 
from  whence  it  came  ? 

Wonderful  and  almost  incredible  as  the 
total  disappearance  of  a  fibroid  or  myoma 
may  seem  to  some,  it  is  no  more  myster- 
ious than  this  wonderful  process  of  nature 
w^hich  we  call  involution.  Have  those  who 
doubt  and,  even  worse,  deny  the  power  of 
electricity  to  work  a  change  in  fibroids, 
never  reduced  the  size  and  weight  of  a 
uterus  which  nature  had  failed  to  involute  ? 
Has  Emmett  never  reduced  its  size  by  re- 
pairing a  lacerated  cervix  ?  Have  Churchill 
and  Athill  and  ten  thousand  others  with 
honored  names  never  reduced  the  quan- 
tity of  tissue  in  the  uterus  by  the  appli- 
cation   of  iodine  ?  Have    not   a    hundred 


thousand  others  reduced  the  weight  of 
blood  and  muscle  and  areolar  tissue  in  the 
heavy  uterus  by  means  of  glycerine  and 
hot  water  and  other  therapeutic  measures  ? 
Then  why  in  the  name  of  reason  and 
justice  deny  that  an  agent  which  we  can 
see  blanching  tissues  before  our  eyes,  and 
making  muscles  of  every  kind  contract,  why 
deny,  he  said,  that  it  can  diminish  the 
blood  supply  to  and  favor  the  fatty  de- 
generation and  absorption  of  the  fibrous 
or  myomatous  uterus  ? 

1  he  electrical  treatment  of  fibroids  re- 
duced to  the  above  simple  question,  and 
stripped  of  all  the  extravagant  claims 
which  were  at  first  made  for  it,  stands  to- 
day upon  a  foundation  so  strong  and  true 
that  it  will  find  an  honorable  place  in  the 
treatment  of  fibroids  as  long  as  women 
shall  dread  to  die  by  the    surgeon's  knife. 


^0cictj)     §itocttyin%s. 


MONTREAL 


MEDICO-CHIRURGICAL 
SOCIETY. 


Stated  Meeting,  February  22nd,  1895. 

G.  P.  GiRDwooD,  M.D.,    President,    in   the 
Chair. 

Discuss io?i  on  Hypertrophy  of  the  Heart 
apart  from  Valvular  Disease, — Dr.  James 
Stewart  introduced  the  su!)ject  by  a  paper 
on  the  etiology  as  follows  : — 

I  have  been  assigned  the  duty  of  dealing 
with  the  causes  of  cardiac  hypertrophy  other 
than  those  due  to  valvular  disease.  Perhaps  it 
would  have  been  better  if  the  term  enlargement 
of  the  heart  had  been  used  instead  of  hyper- 
trophy, for  the  reason  that  a  pure  and  simple 
hypertrophy  is  rarely  met  with,  I  will  confine 
my  remarks  chiefly  to  hypertrophy,  but  it  will 
be  necessary  to  refer  frequently  to  the  almost 
constant  presence  of  dilatation. 

The  causes  of  cardiac  hypertrophy  have  been 
recently  attracting  great  attention,  but  not 
more  than  the  condition  merits  on  account  of 
its  great  practical  importance.  No  doubt  a 
great  deal  can  be  done  to  stay  the  progress  of 
an  advancing  hypertrophy  if  the  cause  or 
causes  at  work  are  clearly  recognized. 

A  discovery  of  the  causes  is  essential  to  judi- 
cious therapeutics. 


244 


THE  CANADA  MEDICAL  RECORD. 


I  can  only  deal  with  the  more  important  car- 
diac hypertrophies,  and  even  those  must  be 
dealt  with  briefly. 

The  principal  causes  of  cardiac  hypertrophy 
other  than  disease  of  the  valves,  of  the  myocar- 
dium and  of  adherent  pericardium  can  be 
divided  for  the  sake  of  convenience  as  follow?  ; 

1.  Organic  changes  in  the  arterial  system, 
including  obsolesence  of  the  capillaries,  and 
also  congenital  narrowing  of  the  arteries. 

2.  The  overfilling  of  the  circulation. 

3.  The  circulation  in  the  blood  of  either 
foreign  substances,  or  an  excels  of  substances 
which  in  small  quantities  is  a  normal  state. 

4.  Causes  that  act  in  a  manner  still  unknown 
on  the  general  or  cardiac  .nervous  system. 

I.  Arterio  Scleros'.s.-^'\\i\'s>  is  one  of  the  most 
frequent  causes  of  cardiac  hypertrophy,  and 
within  the  past  few  years  has  attracted  great 
attention.  It  is,  as  is  well  known,  a  frequent 
condition  after  the  fiftieth  year,  but  it  is  not  by 
any  means  a  constant  change  in  the  physically 
degenerative  period  of  life.  It  is  not  uncom- 
mon to  often  find  the  arteries  of  aged  people 
free  from  any  such  change.  Bamberger  men- 
tions that  on  several  occasions  he  has  found 
the  aiteries  free  from  sclerotic  changes  as  late 
as  the  ninetieth  year.  Then  there  is  the  famous 
case  recorded  by  Harvey,  where  sound  vessels 
were  found  in  a  man  at  the  very  advanced  age 
of  153  years. 

Although  it  is  uncommon  to  meet  with 
marked  sclerosis  under  the  thirtieth  year,  it  still 
occurs  sufficiently  frequently  to  make  it  matter 
of  great  clinical  interest  and  importance. 

The  most  important  form  of  arterio-sclerosis 
is  that  which  occurs  as  a  diffuse  process,  in 
men  from  the  th.irtieth  to  the  fifty-fifth  year. 

Councilman,  at  the  meeting  of  the  Associa- 
tion of  American  Physicians  in  1891,  read  a 
valuable  paper  on  the  connection  between 
arteiial  disease  and  tissue  changes.  His 
observations  were  founded  on  the  examinaliim 
of  foity-one  cases  which  had  been  autopsied  at 
the  Johns  Hopkins  Hospital.  He  divided 
aiterio-sclerotic  changes  into  three  different 
grou])s — the  nod  ilar,  senile  endarteritis  and 
tfic  diffuse  arteriosclerosis.  All  these  varieties 
are  followed  at  times  by  hyjjertrophy  of  the 
heart. 

In  the  nodular  form  the  changes  are  limited 
to  the  aorta  and  large  arteries.  The  aorta  is 
covered  here  and  there,  especially  at  its  origin, 
with  elevated  patches,  cartilaginous  or  calcified 
in  a))pearance.  Otherwise  the  lumen  of  the 
vessel  presents  a  smc  oth  a.'^pecf. 

In  this  nodular  form  of  arterio-sclerosis, 
hypertrophy  of  the  heart  is  very  common.  In 
advanced  cases  it  is  to  a  great  or  less  extent 
almost  constant,  the  loss  of  elasticity  in  the 
vessels  throwing  more  work  on  the  heart. 
When  the  heart  increases  in  size  it  in  its  turn 
tends  to  increase  the  arterial  changes,  so  that 


we  have  the  one  condition  keeping"up  the  other,    ^™ 
a  morbid  circle  being  formed.  3H 

In  the  typical  senile  endarteritis,  the  aorta 
and  its  larger  branches  are  converted  into  al- 
most rigid  calcareous  tubes.  The  arteries  are 
irregularly  dilated  and  lengthened.  Cardiac 
hypertrophy  is  not  as  constant  a  result  of  the 
senile  endarteritis  as  it  is  of  the  other  varieties. 
This  is  in  a  great  measure  due  to  obsolescence 
of  so  many  of  the  smaller  arterial  branches  as 
people  grow  older.  It  is  brought  about  by  the 
loss  of  the  elasticity  in  the  arteries,  so  that  the 
blood  flow  in  the  capillaries  from  being  conti- 
nuous becomes  intermittent,  and  in  many  areas 
finally  ceases. 

No  doubt  hypertrophy  of  the  heart  in  a  cer- 
tain sense  must  of  necessity  occur  when  the 
vessels  have  to  a  great  extent  lost  their  elasti- 
city ;  but  owing  to  the  cutting  off  of  capillary 
areas  this  hypertrophy  is  more  relative  than 
absolute. 

"  The  changes  in  the  arteries  due  to  age 
proceed  slowly,  imperceptibly,  and,  so  far  as  the 
individual  himself  is  concerned,  unconsciously. 
If  the  heart  responds  normally  to  the  calls  for 
extra  exertion  demanded  of  it,  the  individual 
gradually  descends  into  the  vale  of  years,  quite 
unconscious  whether  he  has  a  heart  or  not.  If 
this  knowledge  is  forced  upon  him,  trouble  is 
not  far  off." — Balfour  ^The  Scj He  Heart'). 

The  diffuse  form  of  arterio-sclerosis  is  in 
many  respects  the  most  important;  here  the 
arterial  changes  are  widespread,  affecting  the 
whole  arterial  system  to  a  gi  eater  or  less 
extent.  .More  than  half  of  Councilman's 
cases  were  examples  of  the  diffuse  varieties, 
the  youngest  being  a  negro  aged  twenty-three, 
the  oldest  was  a  mm  aged  sixty.  The  great 
majority  of  cases  ranged  in  age  between  forty 
and  fifty-five.  Hypertrophy  was  present  in 
every  case,  in  some  it  reached  an  extreme  degree. 

Myocardial  changes  were  found  to  be  fre- 
quent, their  extent  depending  on  the  degree  of 
involvement  of  the  coronary  arteries  in  the 
sclerotic  process.  Dilatation  of  the  heart  is 
nearly  always  a  constant  accompaniment  of  the 
diffuse  sclerosis  of  the  arteries.  In  fact,  in  all 
varieties  of  sclerotic  arteries  the  heart  is  not 
only  hypertrophied,  but  also  dilated.  Cohn- 
heim  has  said  that  the  great  majority  of  all  idio- 
pathic cardiac  hypertrophies  are  eccentric,  and 
that  non-eccentric  hypertrophy  has  chiefly  a 
theoretic  interest.  I'hc  dilatation  in  these 
cases  may  be  so  excessive  as  to  give  rise  to  the 
leaking  of  the  valves. 

Clinically  there  is  a  difference  between  the 
diffuse  arterio-sclerosis  and  the  senile  endarteri- 
tis, the  former  being  characterized  by  the  high 
aiterial  pressure,  a  condition  which  is  not  i)re- 
sent  in  the  latter,  at  any  rate,  when  pure  and 
simple.  If,  however,  the  kidneys  have  under- 
gone degenerative  changes,  the  arterial  pressure 
will  be  increased. 


THE   CANADA   MEDICAL   RECORD. 


245 


The  difference  in  the  two  states  is  chiefly- 
accounted  for  by  the  slo.vness  of  onset  in  the 
senile  disease  as  compared  with  the  quicker 
process  in  the  diffuse  form.  In  the  former  the 
atrophy  of  tissue  is  also  greater. 

The  chief  cause  of  arterial  degeneration  in 
advanced  life  is  the  natural  decay  of  tissues. 
In  the  diffuse  form  the  primary  event  is  a 
degeneration  of  the  media  of  the  large  and 
small  arteries.  As  to  how  this"  is  brought 
about,  opinions  differ.  There  can  be  no  ques- 
tion that  the  resisting  ])ower  of  the  arterial  tis- 
sues varies  much  in  different  persons.  In  many 
people  they  are  the  weakest  spot — the  locus 
minor  is  rcsistentiic.  There  is  abundant  proof 
that  this  proneness  to  early  decay  is  frequently 
hereditary.  As  to  the  exciting  causes  of  early 
decay  the  following  may  be  mentioned  :  over- 
eating, the  constant  use  of  alcohol, — especially 
beer,  excessive  smoking,  hard  manual  labor, 
athleticism,  poisoning  by  lead  or  mercury,  re- 
tention of  uric  acid  (so-called  gouty  arteritis), 
the  toxines  of  the  various  infectious  diseases, 
etc. 

In  a  lecent  paper  in  the  fojiriial  of  Patho- 
logy and  Bacteriology  HoUis  suggests  that  the 
entry  of  various  micro-organisms  played  a  lead- 
ing part  in  inducing  atheromatous  changes. 

I  will  first  say  a  few  words  in  regard  to  the 
abuse  of  alcohol  in  inducing  hypertrophy  of 
the  heart,secondarily  through  producing  arterio- 
sclerosis, and  primarily  without  any  arterial 
change  whatever.  In  Germany,  where  beer  is 
the  favorite  beverage,  what  is  commonly  known 
as  the  Munich  beer-heart  is  very  common.  It 
is  the  form  of  heart  lesion  in  more  than  55.3  per 
cent,  of  all  heart  cases.  It  may  exist  with  or 
without  any  arterio-sclerosis.  In  the  great 
majority  of  cases,  according  to  Mi^hr,  it  exists 
independently  of  any  arterial  changes.  The 
fact  that  in  countries  where  stronger  alcoholic 
drinks  are  consumed  than  in  Germany,  renders 
it  highly  probable  that  the  cardiac  hypertrophy 
from  the  use  of  large  quantities  of  beer  is  due, 
more  to  the  filling  of  the  vessels  with  fluid  than 
from  any  direct  action  of  the  alcohol  itself.  The 
quantities  consumed  daily  by  every  steady  beer 
drinker  in  Germany  amounts  to  three  or  four 
quarts — five,  six  and  even  seven  quarts  is  the 
daily  allowance  of  not  a  few. 

"Four  quarts  of  beer  contains  about  eight 
ounces  of  hydrocarbons  in  solution,  and  there- 
fore capable  of  complete  abs  ^rption  into  the 
circulation." — Strunpell. 

It  is  therefore  easy  to  understand  how  the 
heart  is  over-burdened,  especially  when  one 
considers  that  obesity  is  present  as  a  rule  in 
those  who  use  beer  so  freely.  In  some  cases 
it  would  seem  that  alcohol  has  a  direct  action 
in  causing  increased  pressure  in  the  vessels. 
Even  allowing  that  alcohol  may  have  no  direct 
influence  in  bringing  about  the  hypertrophy  of 
the  heait,  it  no  doubt    promotes  the  degenera- 


tive changes  in  the  heart  muscle  and  cardiac 
nerves,  which  at  least  render  the  heart's  action 
inadequate  and  the  circulation  imjjerfect. 

The  consumption  of  excessive  quantities  is 
generally  found  in  those  who  eat  to  excess  and 
who  are  engaged  in  severe  toil — all  causes 
which  tend  to  induce  cardiac  hypertrophy.  In 
indolent  people  we  have  obesity  which  is  in 
some  respects  as  injurious  as  excessive  work. 

The  consumption  of  large  quantities  of  food 
and  beer  gives  rise  also  to  a  hyperaemia  of  the 
intestinal  vessels,  which  greatly  increases  the 
pressure  in  the  arteries  It  is  generally  allow- 
ed the  strong  tea,  coffee  and  tobacco  have  a 
direct  action  in  causing  increased  pressure  in 
the  arterial  system.  They  are  all  promoting 
causes  of  the  cardiac  changes.  Seldom  do  we 
find  anyone  prominent.  Practically  we  nearly 
always  find  over-eating,  drinking,  smoking,  the 
excessive  use  of  tea  or  coffee,  together.  Nico- 
tine in  the  lower  animals  causes  a  great  fall  of 
blood  pressure,  but  from  this  we  are  not  to  con- 
clude that  the  continuous  use  has  not  an  oppo- 
site action  on  man,  as  has  been  done. 

The  course  of  this  hypertrophy  varies  consi- 
derably. In  the  great  majority  of  cases  it  is 
found  that  the  increased  power  is  sufficient  for 
a  lengthened  period  to  carry  on  the  circulation 
compatible  with  a  fair  degree  of  health,  but  in 
not  a  few  cases,  especially  in  excessive  beer 
consumers,  an  acute  heart  failure  sets  in,  which 
rapidly  proves  fatal  ;  this  often  happens  with- 
out any  degenerative  changes  in  the  heart  mus- 
cles. Bauer  has  reported  a  number  of  cases 
where  heart  iailure  has  set  in  a  very  short  time 
after  the  hypertrophy  developed,  and  in  which 
fatal  resiflt  followed — a  veritable  heart  paralysis, 
as  he  calls  it.  In  the  majority  of  casts,  if  the 
cause  is  not  removed,  gradual  degenerative 
changes  go  on  in  the  heart  muscle,  which  finally 
lead  to  general  dropsy. 

Another  important  cause  of  cardiac  hyper- 
trophy is  over-work,  leading  to  strain  of  the 
heart  muscle.  Both  ventricles  are  usually  in- 
volved, and  dilatation  and  hypertrophy  are  al- 
ways found  together.  It  is  met  with  in  those 
whose  work  entails  severe  muscular  efforts. 
On  superficial  examination,  such  patients  usu- 
ally present  a  very  healthy  appearance.  On 
physical  examination,  however,  the  chest  is 
found  to  be  barrel-shaped,  and  the  second 
sound,  both  aortic  and  pulmonic,  is  accentuated. 
It  has  been  met  with  in  soldiers,  especially 
during  active  service  in  the  field.  DaCosta, 
Frantzel  and  many  others  have  contributed  valu- 
able papers  on  this  particular  form  of  heart 
strain.  It  does  not  differ,  however,  in  any  res- 
pect from  that  met  with  from  other  forms  of 
over-work. 

In  a  recent  paper  on  cycling,  B.  Ward 
Richardson  points  out  that  the  ultimate  action 
of  excessive  cycling  is  to  increase  the  size  of 
the  heart,  to  render  it  irritable  andhypersensi- 


246 


THE  CANADA   MEDICAL   RECORD. 


live  to  motion,  the  cycling  acting  upon  it  like  a 
stimulant.  Tlie  over-development  of  the  heart 
under  the  continued  and  extreme  over-action 
affects  in  turn  the  resilience,  modifies  the 
natural  blood-pressure,  and  favors  degenera- 
tive structural  changes  in  the  organs  of  the 
body  genet  ally.  Every  medical  man  here 
must,  I  think,  have  met  with  instances  of 
cardiac  hypertrophy  in  athletes.  There  can 
be  no  doubt,  that  in  such  a  violent  game  as 
lacrosse  this  condition  develops.  Cardiac 
hypertrophy  from  overwork  may  be  recovered 
from,  or  it  may  go  on  to  i^rogressive  heart 
failure.  It  develops  more  rapidly,  and  more 
often  affects  those  who  at  the  same  time  use 
alcohol  in  any  form  to  excess. 

It  is  easy  to  understand  how  severe  muscu- 
lar efforts  bring  about  hy])ertrophy  of  both 
ventricles. 

Very  rare  causes  of  cardiac  hypertrophy  are 
congenital  narrowing  of  the  arteries  and 
general  dilatation  of  the  blood  vessels.  The 
former  is,  according  to  some,  far  from  rare, 
and  it  is  held  that  in  aiany  cases  of  enlarge- 
ment of  the  heart  from  over-exertion  the  pre- 
disposing cause  is  congenitally  narrow  vessels. 

In  severe  cases  of  lead  poisoning  cardiac 
hypertrophy  is  very  commonly  met  with,  due 
mainly  to  the  parenchymatous  and  interstitial 
changes  in  the  kidneys  and  arterial  sclerosis. 
These  arterial  and  nephritic  changes  are  very 
constant  phenomena  of  severe  lead  poisoning. 

The  explanation  usually  given  of  the  action 
of  lead  on  the  kidneys  and  arteries  is  that  it 
induces  gout.  Sir  William  Roberts,  however, 
believes  that  lead  does  not  induce  gout.  He 
considers  that  the  gouty  diathesis  and  lead 
poisoning,  while  differing  in  all  other  respects, 
have  one  tendency  or  vice  in  common,  viz., 
the  tendency  to  uratosis.  However  the  facts 
may  be  explained,  there  can  be  no  doubt  about 
the  influence  of  lead  in  bringing  about  sclerotic 
changes  in  the  kidneys  and  arteries,  and  thus 
leading  to  hypertrophy.  These  changes,  next 
to  the  encephapathy,  constitute  the  most  set  ious 
effects  of  lead  poisoning,  effects  which,  if  their 
cause  is  not  early  recognized,  will  infallibly 
lead  to  irretrievable  mischief. 

Cardiac  hypertrophy  is  the  most  constant 
change  in  the  heart  in  gouty  subjects.  It  is 
nearly  alway  present,  differing  in  degree  accor- 
ding to  its  intensity  and  age  of  the  patient.  It 
is  in  some  cases  combined  with  dilatation  and 
myocardial  changes,  especially  fatty  degenera- 
tion. It  is  caused  by  the  widesjiread  arterial 
and  kidney  changes  so  common  in  gouty  sub- 
jects. In  forty-nine  cases  examined  by  Dr. 
Norman  Moore,  the  average  weight  of  the  heart 
was  161.^  ounces.  Gout  may  cause  hypertrophy 
without  first  bringing  about  arterial  organic 
changes.  In  this  connection  it  will  be  conve- 
nient to  discuss  the  cardiac  hypertrophy  which 
is  so  frequently  found  in  cases  of  sub-acute  and 


chronic  Bright's  disease.  The  variety  of 
Bright's  disease  which  is  most  frequently  attend- 
ed by  cardiac  hypertrophy  is  the  interstitial. 
For  many  years  the  connection  between  the 
circulating  and  kidney  changes  has  been  a  sub- 
ject which  has  given  iri'-e  to  a  great  de.'i  .->  ...  - 
cussion. 

There  is  no  doubt  that  cardiac  hypcniwpiiy 
may  occur  in  a  simple  Bright's  disease  without 
any  involvement  of  the  general  arteries.  We  have 
probably  two  factors  contributing  to  the  hyper- 
trophy, the  increased  pressure  in  the  circula- 
tion caused  by  the  necessity  of  getting  rid  of 
waste  matters.  As  a  great  number  of  capillary 
districts  are  obliterated  by  the  disease,  the  heart 
must  increase  in  strength  in  order  to  effect  the 
necessary  elimination  ;  but  the  chief  cause  for 
the  hypertrophy  of  the  left  ventricle  is  the 
retention  in  the  blood  of  matters  which  in  a 
normal  state  of  the  kidneys  would  be  elimin- 
ated. This  causes  high  arterial  tension  and 
gives  rise  in  consequence  to  in'^ren.sed  work 
and  consequently  to  hypertrophy. 

The  last  group  of  causes  giving  rise  to  car- 
diac hypertrophy  which  it  is  my  intention  to 
speak  of  is  the  neurotic  group.  To  this  be- 
longs the  enlargement  coming  in  exophthalmic 
goitre,  essential  tachycardia,  insanity,  prolonged 
emotional  disturbance,  etc.  The  excessive 
action  of  the  heart  in  these  cases  leads  to 
enlargement,  but  little  is  known  about  the  inti- 
mate changes  in  the  nervous  system  which 
brings  them  about.  Our  knowledge  of  the 
changes  which  take  place  in  the  nervous  mechan- 
ism of  the  heart  is  very  slight  indeed.  It  is 
highly  probable  that  in  the  case  of  heart  changes 
coming  on  during  the  course  of  exophthalmic 
goitre,  essential  tachycardia  and  from  the  exces- 
sive use  of  tobacco,  tea  and  coffee,  the  changes 
are  of  a  molecular  nature.  There  are  very  good 
grounds  for  believing  that  all  the  essential 
symptoms  of  exophthic  goitre  are  due  to  the 
action  of  certain  toxines  generated  from  the 
thyroid  gland.  Possibly  it  may  be  found  that 
essential  tachycardia  is  brought  about  also  by 
a  chemical  poison  generated  within  the  body. 
The  hypertrophy  and  dilatation  of  the  heart 
occurring  in  exophthic  goitre  reaches  some- 
times an  extreme  degree,  and  cases  are  not 
uncommon  where  deaih  is  the  direct  result  of 
degeneration  occurring  in  the  heart  muscle.  I 
am  not  aware  of  any  fatal  case  of  tobacco-heart. 
It  is  qiiiie  possible  that  such  a  heart  might  give 
way  at  last  under  the  continuous  strain,  but 
fortunately  the  cause  is  easily  delected,  and  if 
removed  the  effects  disapi)ear,  although  to  this 
there  are  rare  exceptions.  An  abiding  palpi- 
tation has  been  described  even  after  tobacco 
has  been  given  up. 

The  enlargement  of  the  heart  occurring  in 
tlie  course  of  infectious  fevers  is  mostly  due  to 
dilatation  of  the  cavities,  and  hence  is  ])roj)erly 
beyond  the  range  of  my  subject.     The  subject 


THE  CANADA  MEDICAL  RECORD. 


247 


is  one  of  very  great  importance.  I  recently  saw 
a  case  of  typhoid  fever  where  a  fatal  result 
came  about  indirectly,  if  not  in  a  measure  di- 
rectly, from  heart  dilatation  consequent  on  a 
secondary  infection. 

A  word  more  about  the  symptoms  and  phy- 
sical signs  of  cardiac  hypertrophy. 

The  recognition  of  cardiac  hypertrophy  is 
easy  when  it  is  well  marked,  but  difficult,  if 
not  impossible,  when  slight.  I'here  is  seldom 
any  pronounced  subjective  symptoms  while 
the  cardiac  muscle  retains  its  normal  vigor. 
It  is  only  when  degenerative  changes  have  .«et 
in  that  the  patient  feels  that  he  has  a  heart. 
When  this  lakes  place  the  symptoms  do  not 
differ  from  those  of  cardiac  failure  brought 
about  from  valvular  disease. 

The  physical  signs  of  an  hypertrophied  left 
heart  are  increased  tension  in  the  radials,  well- 
marked  apex  beat  and  accentuated  aortic 
second  sound.  When  the  right  heart  is  hyper- 
trophied we  have  an  accentuated  second  pul- 
monary sound.  'I  hese  signs  are  only  of  value 
as  pointing  to  increased  tension  in  the  various 
vessels,  and  when  this  has  lasted  some  time  we 
naturally  conclude  that  there  is  hypertrophy. 
If,  however,  a  cause  which  has  been  in  opera- 
tion for  some  time  is  no  longer  present,  the 
signs  of  increased  tension  will  have  disappear- 
ed, although  the  hypertrophy  remains.  Per- 
cussion is  no  doubt  of  value  in  many  cases  in 
detecting  marked  hypertrophy,  but  for  slight 
degrees  it  can  give  us  no  reliable  information. 
The  shape  of  the  chest  has  much  to  do  with 
the  extent  of  cardiac  dulness.  When  it  is 
barrel-shaped,  a  large  heart  will  present  a  no 
greater  degree  of  dulness  than  a  small  heart  in 
a  flattened  chest.  A  great  degree  of  dulness 
can  only  take  place  in  dilatation.  Again,  a 
large  heart  may  be  more  or  less  entirely  cover- 
ed by  an  emphysematous  or  hypertrophied 
lung. 

Dr.  Adami  discussed  the  anatomy  and  expe- 
rimental pathology  as  follows  : 

I  shall,  I  think,  best  satisfy  you,  and  at  the 
same  time  myself,  if  what  I  contribute  to  this 
evening's  discussion  takes  the  form  of  a  series  of 
notes  upon  the  experimental  pathology  and  the 
anatomy  of  cardiac  hypertrophy,  rather  than 
that  of  an  ncademic  survey  of  the  subject  from 
the  c'inical  ,stand[)oint.  Frequently,  it  is  true, 
I  must  of  necessity  illustrate  what  I  have  to 
say  by  reference  to  clinical  history,  but,  on  the 
whole,  I  shall  leave  the  clinical  aspects  to  be 
dealt  with  by  those  more  capable. , 

In  the  first  place,  if  we  study  the  causes  of 
hypertrophied  heart,  whether  of  hypertrophy  of 
one  or  both  sides,  we  see  this  that  reading  the 
clinical  history  of  these  cases  the  assigned 
causes  of  hypertrophy  may  be  summed  up  under 
the  heading  oS.  'nicreased  work.  This  one  head- 
ing may  be  subdivided  into  three, — increased 
work  due  to  resistance  from  within,    increased 


work  due  to  resistance  from  without,  increased 
work  due  to  nervous  stimulation  and  augmen- 
tor  action.  I  shall  not  discuss  this  last  subdiv- 
ision, because  frankly  we  are  ignorant  how 
far  the  hypertrophy  that  occurs  in  exophthalmic 
goitre  and  allied  conditions  is  due  to  heightened 
blood  pressure,  and  how  far  it  is  secondary  to 
excitation  of  the  accelerators  or  augmentors. 

Of  the  increased  resistance  from  within,  or 
increased  tension,  the  main  causes  are,  height- 
ened pressure  in  the  arterial  blood  stream,  and 
secondly,  obstruction  to  the  onward  passage  of 
blood  within  the  heart  itself,  by  stenotic  dis- 
eases of  one  or  other  orifice.  Of  resistance  from 
without,  the  one  great  cause  is  pericardial  ad- 
hesion. To-night  we  have,  as  far  as  possible, 
to  ieave  out  the  subject  of  valvular  disturbance, 
and  I  shall  neglect  nervous  disturbances.  There 
is  still  the  large  field  of  hypertrophy  due  to 
increased  arterial  pressure,  and  the  pericardial 
adhesion.  In  all  these  cases,  the  individual 
fibres  of  the  heart  muscles  of  the  affected  regions 
have  to  contract  under  increased  difficulty,  they 
have  to  carry  or  contract  against  a  greater  load, 
and  as  a  result  of  this,  just  as  is  the  case  with 
the  skeletal  muscles,  with  the  muscles  in  the 
blacksmith's  arm,  and  the  muscles  of  the  body 
in  the  all-round  athlete,  increased  work  brings 
about  increased  growth — brings  about,  that  is 
to  say,  hypertrophy  of  the  muscle. 

Into  the  subject  of  the  nature  of  this  increased 
growth  I  shall  enter  in  a  few  minutes'  time,  at 
present  I  wish  to  carry  a  word  further  this  par- 
rallel  between  the  behavior  of  the  cardiac  and 
skeletal  muscles,  under  circumstances  in  which 
the  load  is  increased.  Ifyoutakea  skeletal 
muscle,  for  example,  the  gastrocnemius  of  the 
frog,  so  dear  to  the  physiologist,  and  observe 
its  contraction  with  gradually  increasing  loads, 
there  are  two  points  especially  to  be  made  out. 
In  the  first  place,  the  greatest  amount  of  work 
is  not  performed  with  the  smallest  load,  but 
there  is  a  certain  medium  load  with  which  the 
distance  through  which  the  load  is  pulled  mul- 
tiplied by  the  weight  of  the  load  gives  tha  big- 
gest result.  This  product  of  weight  moved  and 
the  distance  through  which  it  is  moved  is  the 
work  done  by  the  muscle.  The  most  work, 
therefore,  is  done  with  a  medium  load.  The 
second  point  is  that  with  increasing  weights  fast- 
ened or  brought  to  bear  upon  the  muscle,  that 
muscle  in  its  resting  state  becomes  more  and 
more  elongated,  and  with  regularly  increasing 
weights  attached,  the  shortening  attained  by 
the  contracted  muscle  constantly  diminishes. 
Or,  to  put  the  matter  in  a  slightly  different  light, 
and  to  combine  these  two  statements  of  fact, 
although  with  a  certain  medium  load  the  great- 
est amount  of  work  is  done,  nevertheless  with 
that  medium  load  the  muscle  in  contracting  does 
not  attain  to  the  same  amount  of  shortening  as 
it  does  with  a  lesser  load. 

Let  me  now  apply  these  observations  to  what 


248 


THE   CANADA   MEDICAL   RECORD. 


is  found  in  the  ventricular  muscles  of  mammals. 
Experimentally,  the  amount  of  work  performed 
by  the  ventricles  of  the  mammalian  heart  can 
be  increased  by  ligaturing  the  aorta  with  a  sip- 
loop  ligature,  and  drawing  this  ligature  more 
or  less  tight,  according  lo  need.  (This  is  an 
animal  that  has  been  narcotized  and  curarized 
and  subjected  to  artificial  respiration,  the  heart 
being  exposed  by  maknig  a  window  in  the  ribs.) 
In  such  a  case  as  this,  as  shown  by  Professor 
Roy  and  me,*  the  behavior  of  the  cardiac 
muscle  can  be  observed  and  recorded  by  an 
apparatus,  of  which  I  give  a  rough  diagram. 
The  ends  of  this  apparatus  are  attached  to  the 
surface,  say  of  the  left  veniricle,  by  fine  threads, 
and  now  it  is  possible  to  observe  upon  the 
recording  drum  the  extent  of  contraction  of  the 
portion  of  muscle  benveen  the  two  points  under 
different  pressures  within  the  heart.  Narrow 
the  aorta  by  drav\ing  the  ligature  tight  and  the 
pressure  is  increased.  Under  these  conditions 
it  is  found  that  the  ventricular  muscle  reacts 
exactly  Along  the  same  lines  as  does  the  gastroc- 
nemius of  the  trog. 

Similar  results  are  obtainable  if,  instead  of 
increasing  the  pressure  in  the  arterial  system 
by  narrowing  the  aorta,  we  increase  the  work  of 
the  heart  by  increasing  the  amount  of 
blood  passing  throrgh  it,  either  temporarily,  by 
pressure  upon  the  abdomen,  whereby  a  large 
quantity  of  blood  is  expelled  from  the  abdo- 
minal viscera,  or  by  injecting  into  venous  cir- 
culation some  few  hundred  cubic  centimetres 
of  defibrinated  blood.  The  results  in  all  these 
cases  are  the  same.  By  the  instrument  just 
described  it  is  easy  to  see  that  the  heart  is 
more  filh^d  in  diastole,  so  that  the  two  ends  of 
the  levers  are  pushed  further  apart,  and  that  in 
systole  the  ends  do  not  approximate  so  nearly 
as  in  the  condition  when  there  is  less  resistance 
or  less  blood  ])0uiing  through  the  organ. 

It  is  seen  from  these  observations  that  with 
increased  pressure  with  the  ventricle  the  wall 
expands  in  diastole.  There  is  dilatation  of  the 
heart.  But  with  the  increased  load  to  contract 
against,  the  fi'ires  do  not  shorten  lo  the  sa-iie 
extent ; — that  is  to  say,  with  increa.sed  work  of 
the  heart  there  is,  necessarily,  accom|.>anying 
the  dilatation  in  diastole,  a  dilatation  in  systole. 
All  the  blood  is  not  expelled  in  systole.  There 
is  of  necessity  residual  l>/ood,  as  Roy  and  I 
termed  it,  in  the  ventricular  chambers. 

There  is  a  general  belief  that  the  healthy  heart, 
even  under  conditions  of  increased  work,  con- 
tracts completely,  so  thai  the  chamber  is  emp- 
tied at  the  end  of  systole.  From  what  1  have 
said  it  will  be  s-:;en  that  this  is  not  the  case. 
One  can  go  further  and  prove  for  one's  self  that 
even  under  ordinary  conditions  the  mammalian 
heart  does  not  complciely  exjjel  all  the  blood 
within  the  ventricles.     By  taking  a  dog  that  has 


*  Huart  liiTit  anil  pulsf  waves.  I'rartitiimir,  Kclini.-irv.  18!M, 
p.  «1. 


been  curarized  and  subjected  to  artificial  respi- 
ration, opening  the  chest  wall,  making  an  inci- 
sion at  the  very  apex  of  the  left  ventricle,  so  as  just 
not  to  completely  enter  the  cavity,  then  it  is  easy 
to  push  the  little  finger  into  the  cavity  thrnugh 
the  thin  apex  without  the  loss  of  a  drop  ut  blood. 
The  heart  action  is  not  recognizably  disturbed 
by  this  procedure,  and  it  can  be  felt  that  while 
the  walls  of  the  ventricle  in  the  lower  two-thirds 
up  to  the  aspices  of  the  papillary  muscles 
close  completely  round  the  finger,  there  is  clear 
space  in  the  upper  third  which  is  not  and  can- 
not be  emptied  of  blood. 

Although  it  may  seem  at  first  sight  to  have 
no  direct  bearing  upon  the  subject  of  this  even- 
ing's discussion,  nevertheless  it  is  worth  while 
to  make  a  few  remarks  upon  this  subject,  inas- 
much as  it  is  so  intimately  associated  with  con- 
ditions of  hyperti-ophy  wiihout  valvular  disease. 
It  is  quite  possible  that  where  there  is  increased 
work  to  be  performed  by  the  heart,  there  is 
some  economy  of  the  action  of  the  organ  when 
there  exists  a  certain  amount  of  residual  blood 
in  and  dilatation  of  the  ventricles.  Taking  the 
ventricular  chamber  as  a  sphere,*  there  is  this  to 
be  noted  concerning  the  relationship  between 
the  circumference  of  the  sphere  and  its  contents, 
namely,  that  as  a  sphere  expands,  its  cubic  con- 
tents increase  out  of  all  proportion,  I  was  going 
to  say,  to  increase  in  cubic  contents  and  increase 
in  circumference  is  by  no  means  an  arithmetic 
ratio. 

If  the  circumferences  be  taken  as  abscissse, 
and  the  corresponding  volumes  as  the  ordin- 
ates,  the  curve  of  successive  values  is  what  is 
known  to  mathematicians  as  a  cubical  parabola. 
From  this  it  follows  that  a  degree  of  shortening 
of  the  fibres  of  the  heart  wall,  sufficient,  let  us 
say,  to  reduce  the  circumference  of  the  ventri- 
cle one  inch,  will  cause  a  greater  diminution  in 
voluvie  (a  greater  output)  the  more  dilated  the 
ventricle  is  at  the  beginning  of  its  contraction. 
For  example,  a  diminution  of  the  circumfer- 
ence by  one  inch  of  a  sphere  whose  circumfer- 
ence is  ten  inches  causes  a  diminution  of  the 
volume  or  an  output,  in  the  case  of  the  heart, 
equal  to  4.5  cubic  inches,  while  a  diminution 
by  one  inch  in  the  circumference  of  a  sphere 
five  inches  round  causes  a  diminution  or  an 
output  of  only  1.027  cubic  inches,  althougli 
in  the  first  case  the  circumference  was  reduced 
only  by  one-tenth,  while  in  the  other  case  it 
was  reduced  to  one-fifth.  That  is  to  say,  if  we 
have  a  dilated  heart,  the  fibres  will  need  to  con- 
tract a  very  small  amount  in  order  to  expel  n 
given  amount  of  blood,  compared  with  the 
amount  they  would  have  to  contract  in  the  nor- 
mal undilated  heart. 

There  are  other  factors  lo  be  taken  into  ac- 
count, it  is  true,  and  Roy  and  I  went  a  little 
inlb  this  subject  in  our  j^aper  published  in  the 


•  'J'lif  siilieri'  is  tin-  nearest  j;ei)nietrioal    figure  that  can  \w 
•ini>l<)ye([  here  fur  purposes  of  illustration. 


THE  CANADA  MEDICAL  RECORD. 


249 


Philosophical  Transactions.^  All  that  I  wish 
to  do  here  is  to  ])oinl  out  that  it  is  possible  th;U 
in  a  hard-working  heart  a  certain  amount  of 
dilatation,  with  jjresence  of  residual  blood  by 
diminishing  the  extent  which  each  fibre  is 
called  upon  to  contract,  may  really  be  an 
economy  to  the  organ  as  a  whole. 

It  follows  from  these  observations  that  hyper- 
trophy is  never  primary ,  dilatation  always  pre- 
cedes hypertrophy.  This  was  recognized  ps 
most  probable  by  Hilton  Fagge ;  few  other 
writers  have  laid  stress  upon  the  point.  If, 
however,  the  heart  musc'e  is  well  nourished, 
where  this  dilatation  is  due  to  increased  work, 
by  Paget's  law  hypertrophy  ensues,  and.  tie 
numerical  hypertrophy  or  hyperplasia  of  the 
ventricular  muscle  fibre  will  have  the  effect  of 
lessening  the  load  of  each  individual  fibre. 
Consequently,  with  a  lessened  load,  each  fibre 
willjcontract  more  completely  and  the  dilatation 
will  tend  to  disappear.  Where  this  is  the  case 
we  have  what  is  known  as  sim])le  hypertrophy. 

There  can  be  no  doubt  that  the  early  stages, 
where  ample  reserve  force  and  good  compensa- 
tion are  present,  this  simple  hypertrophy  exists 
and  may  persist  for  years.  But  I  would  add 
that  in  the  post-mortem  room  it  is  more  rarely 
to  be  seen  than  is  generally  accepted.  If  a 
hypertrophied  heart,  say  of  Brighi's  disease, 
without  valvular  lesion,  be  examined  within  a 
few  hours  after  death,  in  very  many  cases  Me 
a])pear  to  have  this  simple  hypertrophy.  If, 
however,  time  be  given  for  the  rigor  and  con- 
traction of  the  muscle  to  pass  off,  it  is  found — 
that  at  least  is  my  experience — that  the  cavity 
of  the  left  ventricle  is  distinctly  larger  tha.i  the 
cavity  of  the  normal  heart.  I  would  say  that 
only  in  those  cases  in  which  death  has  occurred 
from  some  intercurrent  disease,  and  not  from 
one  of  the  cycle  of  diseases  associated  with  car- 
diac hypertrophy — only  when  deatii  occurs 
before  the  final  stage  of  the  disease  of  which 
cardiac  hypertrophy  is  an  integral  part — do  we 
obtain  evidence  of  real  simple  hypertrophy. 
Eccentric.,  and  not  simple,  hypertrophy  is  the 
rule, —  that  is  to  say,  hypertrophy  associated 
with  definite  dilatation  of  the  ventricular  cav- 
ities. 

As  for  the  concentric  hypertrophy,  which  is 
said  to  be  observable  in  non-valvular  disease, 
I  feel  more  and  more  assured  that  it  is  falsely 
so  termed  ;  there  is  no  such  thing  as  true  con- 
centric hypertrophy,  fo'  the  condition  implies 
a  lack  of  economy  in  the  work  of  the  organ,  a 
most  unnatural  lack ;  it  implies  that  the  ven- 
trical in  cont'-acting  expends  a  large  part  of  its 
energy,  after  expelling  the  blood,  in  squeezing 
up  the  more  internal  fibres.  Only  within  the 
last  fortnight  I  obtained  a  specimen  of  so-calkd 
concentric  hypertrophy.  The  patient,  an  old 
woman  of  eighty,  in  Dr.  Stewart's  ward  at  the 


*Phil.  Trans,  of  the  Koyal  Society,  London,  1892, 


Royal  Victoria  Hospital,  d.ed  from  cerebral 
apoplexy,  following  upon  extreme  atheroma  of 
the  aorta  and  th?  main  vessels  ;  there  was,  in 
addition,  atheromatous  stenosis  of  the  aortic 
valves,  both  conditions  favoring  the  develop- 
ment of  hypertrophy,  with  dilatation  of  the  left 
ventricle. 

The  old  woman  had  lingered  some  days  in  a 
comatose  condition,  with  presumable  lowering 
of  the  arterial  blood  pressure.  In  addition,  the 
tone  of  ventricular  muscle  had  been  in  all  pro- 
bability considerably  increased  by  digitalis. 
At  any  rate,  at  the  autopsy  a  very  few  hours 
after  death  the  left  ventricle  was  found  hyptr- 
trophied,  and  instead  of  being  dilated  was  so 
firmly  contracted  that  the  only  cavity  left  was 
immediately  around  the  chordae  tendineai. 
The  thickness  of  the  ventricular  muscle  at  the 
junction  of  the  lower  and  middle  thiids  was 
20  mm., — that  is  to  say,  there  was  modeiate 
hypertrophy.  However,  on  coming  to  observe 
this  heart  the  next  day,  the  concentric  hyper- 
trophy had  quite  disappeared.  With  the  pass- 
ing off  of  rigidity  there  was  a  relatively  large 
cavity  left  behind. 

^Vhere  the  left  or  right  ventricle  alone  is 
affected,  the  condition  of  the  ventricle  may  be 
one  of  either  simple  or  eccentric  hypertrophy. 
Where,  on  the  other  hand,  as  Walshe  noted 
more  i^an  thirty  years  ago,  there  is  general 
hypertrophy  of  the  organ,  there  hypertrophy  is 
always  eccentric, 

A  little  consideration  shows  why  this  must 
inevitably  be  the  case.  So  long  as  there  is 
simple  hypertrophy  (hypertrophy  without  dila- 
tation) so  long  the  mitral  valves  remain  compe- 
tent, and  there  is  no  regurgitation  into  the  left 
auricle,  no  increased  work  for  that  organ  to  do, 
no  hypertrophy.  So  soon  as  the  left  ventricular 
muscle  begins  to  fail  and  to  be  unable  to  con- 
tract properly  under  its  load,  dilatation  ensues, 
and  with  this  dilatation  expansion  or  giving  way 
of  the  muscular  ring  around  the  mitral  orifice, 
and  with  this,  relative  incompetence  of  that 
orifice.  It  is  only  when  this  relative  incom- 
petence occurs,  or  when  from  other  causes  the 
mitral  valves  fail  to  perform  their  duty,  that 
there  is  any  possibility  of  the  other  chambers  of 
the  heart  being  called  upon  to  do  increased 
work.  Thus  it  is  that  general  hypertrophy  of 
the  heart  demands  or  is  associated  with  eccen- 
tric hypertrophy  of  the  left  ventricle. 

l~ime  forbids  that  I  should  go  more  fully 
into  this  subject  or  do  more  than  point  out  that 
relative  incompetence  of  the  auriculo-veniri- 
cular  valves  is  more  frequently  found  at  the 
post-rnortem  than  it  is  diagnosed  during  life. 
Relative  incompetence,  therefore,  is  not  neces- 
sarily indicated  by  the  presence  of  a  murmur. 

I  cannot  here  enter  fully  into  the  histological 
nature  of  hypertrophy,  although  perhaps  as  a 
pathologist  it  might  be  expected  that  I  should 
say  some  words  upon  this  point.     I  will  only 


250 


THE   CANADA    ^rEDICAL   RECORD. 


say  that  wliile  one  can,  in  certain  cases  of 
hypertrophy,  make  out  clearly  that  the  indivi- 
t!ual  fibres  have  undergone  a  definite  increase 
in  size,  it  is  far  more  common  to  note,  and  of 
this  there  can  be  no  doubt,  that  there  has  been 
an  actual  numerical  increase  in  the  fibres.  This 
increase  appears  to  be  general  throughout  the 
ventricular  wall,  and  is  possibly,  nay  probably, 
due  not  only  to  a  new  growth  beneath  the 
endocardium  especially,  but  also  to  a  s]>litting 
up  or  division  of  pre-existing  fibres.  It  must 
be  remembered  that  the  heart  muscle  fibte  is 
not  a  single  cell,  but  is  a  compound,  the  result 
of  a  fusion  of  several  cells  into  one  individual 
unit.  As  a  consequence  of  this  it  is  possibly 
more  easy  for  the  fibres  to  split  up  into  inde- 
pendent territories  without  undergoing  tem- 
porary derangement  of  function  than  is  the 
case  with  the  cells  of  those  tissues  formed  of 
isolated  cell  units. 

To  pass  on  now  to  certain  aspects  of  this 
subject  of  hypertrophy  more  immediately  in 
connection  with  this  evening's  discussion,  I 
would  point  out  that  of  the  cases  of  hypertrophy 
without  valvular  lesion,  we  have  to  consider 
in  the  first  place  increased  resistance  through 
the  column  of  blood.  This  could  be  brought 
about  by  increased  amount  of  blood  to  be  pro- 
pelled, or,  in  the  second,  by  increased  resist- 
ance to  passage  in  the  arterial  system.  Of 
these  two  the  first  may  exist  as  a  constitutional 
condition,  but  the  more  one  studies  the  less 
assured  does  one  become  that  there  is  such  a 
condition  as  general  plethora  unless  these  cases 
be  regarded  as  true  plethora  in  which  Tas  in 
German  beer  drinkers)  there  is  oft  repeated 
flusliing  of  the  circulation  with  imbibed  fluid. 
Of  increased  resistance  in  the  arterial  stream 
the  reverse  would  appear  to  be  the  case,  and 
with  funher  studies  of  blood  pressure  in  the 
arteries  one  begins  to  see  that  this  plays  an 
extremely  important  part.  The  hypertrophy 
following  upon  not  only  gouty  conditions  and 
senile  arterio-sclerosis,  but  also  upon  acute 
rheumatism,  chorea  and  chlorosis,  may  be  pre- 
sent with  or  without  lesion  of  the  aortic  or  mitral 
valves  of  sufficient  intensity  to  explain  its 
extent;  so  that  in  all  these  cases  we  have  to 
fill  back  upon  increased  blood  pressure  as  a 
cause  of  hypertrophy. 

Increased  blood  pressure  in  itself  is  capable 
of  setting  up  a  vicious  circle  of  which  one 
segment  may  be  hypertrophy. 

In  the  first  place  it  leads  to  an  increased 
nutrition  of  the  walls  of  the  arteries,  increased 
nutrition  leads  to  increased  connective  tissue 
growth  of  the  walls,  the  increased  fibrous  lis. 
sue  of  the  walls  leads  to  contraction  and 
increased  rigidity  of  those  walls,  the  increased 
rigidity  leads*  to  increased  resistance  to 
ihe  passage  of  liie  blood  current,  the  increased 
resistance  required  increased  propulsive 
power      on      the    pari      of     the      ventricular 


muscle,  that  is  to  say,  increa  ed  work  :  the 
increased  work  of  the  heart  leads  to  over- 
growl  ii  and  hypertrophy,  and  with  t'as,  height- 
ened biood  piessure  and  further  increased 
nutrition  of  the  walls.  And  now  at  last  the 
stage  is  reached,  this  vicious  circle  continuing, 
in  which  either  the  walls  give  way  or  the 
heart. 

The  longer  I  study  the  i)aihology  of  the 
circulation — and  du'ing  the  last  eight  years  I 
have  given  more  time  and  thought  to  this  than« 
to  any  other  brand',  of  my  subject — the  more 
assured  do  I  feel  that  increased  bhod  pressure 
alone  (however  it  be  primarily  brought  about) 
is  sufficient  to  explain  the  anatomical  changes 
so  constantly  seen  in  arteries,  valves  and 
heart  walls,  without  of  necessity  calling  in 
chronic  inflammation  or  specific  agency.  TliC 
changes  I  refer  to  are  arterio-sclerosis,  athe- 
roma, and  general  fibroid  thickening  of  the 
valves.  Perhaps  here  again  I  am  diverging 
from  the  main  subject  of  this  evening's  discus- 
sion, but  I  say  this  as  a  connecting  link  wiih 
what  I  have  just  remarked  and  with  what  is 
about  to  follow. 

While  I  am  far  from,  wishing  to  indicate  that 
this  is  to  be  regarded  as  the  sole  cause  of 
atheromatous  and  arterio-sclerolic  changes,  I 
hold  that  the  changes  I  have  mentioned  can 
one  and  all  be  explained  by  the  increased 
pressure  within  the  vessels  leading  to  an 
increased  passage  of  fluid  from  the  blood  into 
the  sub-endoihelial  layers  of  the  iniima,  to  an 
increased  nutrition,  and  as  a  consequence  to  a 
proliferation  of  connective  tissue  in  this  region, 
which  in  itself  as  it  contracts  cuts  off  its  own 
supply  ofnutiition,  degenerates,  and,  what  is 
more,  leads  to  degeneration  of  surrounding 
parts  by  cutting  off  their  nutrition.  Tlie  evil 
effects  in  arterio-sclerosis,  with  all  its  combined 
lesions,  are  not  necessarily  of  an  iiiflammatory 
origin. 

Let  us  take  now  the  hypertrophied  heart. 
Time  permits  me  to  refer  but  biiefly  to  the 
anatomical  changes  tliat  may  occur  in  it  in  the 
cases  before  us. 

1.  The  overgrowth  of  the  arterial  walls  may 
be  a-sociated  with  an  increased  tendency  to 
the  development  of  fibrous  tissue  in  the  inune- 
diate  neighborhood  of  the  arteries,  and  thus  a 
condition  of  so-called  interstitial  myocarditis 
may  be  set  up  )  or 

2.  Willi  an  increased  fibrosis  of  the  arteries 
the  narrowing  of  the  channel  may  lead  to 
incom|)lete  nutrition  of  the  territory  supplied 
by  each  arterial  twig,  and  as  a  consequence 
ihe  muscle  fibres  at  the  periphery  of  the  terri- 
tory may  be  atrophied  through  lack  of  nutri- 
tion and  be  replaced  by  fibrous  tissue.  This 
is  the  so-called  dysiroi)hic  sclerosis  of  the 
Fi'ench  school,  and  can  frequently  be  seen 
more  especially  in  the  papillary  muscles. 

3.  With  the  arterial  disturbance  there    may 


THE  CANADA  MEDICAL  RECORD. 


251 


be  actual  blocking  of  the  atheromatous  arte- 
ries, and  so  infarctous  areas  may  originate, 
may  undergo  softening,  may  cause  ru[)Uire  of 
the  heart  or  aneurism  of  the  wall,  or  if  the 
period  of  softening  be  successfully  tided  over, 
the  replacement  of  the  necrosed  tissue  leads  to 
cicatricial  development  and  disturbance  of  the 
normal  contraction. 

All  these  cases  liere  mentioned  inevitably 
cause  interruption  to  the  proper  action  of  the 
remaining  fibres,  and  lead  towards  a  final 
failure  of  the  organ. 

Another  set  of  causes  would  seem  to  act 
along  rather  different  lines,  not  so  much  of 
disturbances  in  the  coronary  arteries  as  distur- 
bance in  the  quality  of  the  nutrition,  whereby 
the  heart  muscle  tends  to  undergo  fatty  dege- 
neration. In  the  uncomplicated  case  of  hyper- 
trophy, without  valvular  lesion,  however,  this 
fatty  degeneration  is  rare  ;  more  frequent, 
according  to  the  observations  of  Renaud, 
Browicz  and  Von  Recklinghausen,  there  is  a 
tendency  for  a  sudden  rupture  of  the  heart 
fibres,  from  segmentation  or  fragmentation. 
It  would  seem  as  though,  from  the  very  care- 
ful observations  of  the  last  two,  the  weakened 
condition  of  the  muscles  permits  some  slight 
increase  in  the  work  done  by  the  organ  to 
bring  about,  not  a  local  rupture,  but  a  general- 
ized separation  of  the  fibres. 

Possibly  this  segmentation  may  explain  the 
suddenness  of  many  cases  of  death  in  those 
with  atrophied  and  dilated  hearts.  For  my 
own  part  I  cannot  as  yet  see  that  it  has  been 
proved  with  absolute  satisfaction  that  the  frag- 
mentation of  the  fibres  is  agonal  orpre-agonal. 
Nor,  looking  back,  does  it  seem  to  me  that 
the  most  strongly  marked  cases  that  I  have 
encountered  of  this  fragmentation  have  been 
in  cases  of  sudden  death. 

Lastly,  to  round  off  this  paper,  it  is  neces- 
sary to  say  a  word  concerning  the  hypertro- 
phy that  follows  pericardial  adhesion.  Of  this 
I  may  say  that  I  cannot  recall  any  case  seen 
by  me  in  which  the  hypertnjphy  was  not 
markedly  eccentric.  Most  frequently  the 
hypertrophy  has  disappeared  with,  in  its  place, 
peculiarly  extensive  degenerative  change. 

Dr.  F.  W.  Campbell  described  the  treatment 
as  follows  : 

I  confess  that  when  I  undertook  to  speak  on 
the  ireatment  of  hypertrophy  without  or  apart 
from  valvular  disease,  I  thought  my  work  would 
be  a  comparatively  easy  one.  When,  however, 
I  began  to  look  into  the  subject,  I  found  com- 
paratively little  on  this  s]  ecial  form  of  heart 
disease,  and  what  I  did  meet  with  was  so  mixed 
with  the  treatment  of  valvular  hypertrophy  thai 
it  was  a  somewhat  tedious  task  to  separate  it. 
When  accomplished  it  was  not  satisfactory,  for, 
after  all,  the  treatment  of  cardiac  hypertroph\' 
is  much  the  same,  no  matter  what  is  the  cause. 
At  the  outset  the  enquirer  is  met  with  the  ques- 


tion, "  With  what  hope  may  the  treatment  of 
an  hypertrophied  heart  be  undertaken  ?  "  Can 
we  control  ihe  nourishment  of  the  heart  by  any 
means  possessed  by  cur  art  ?  Some  have  main- 
tained that  this  can  be  done,  but  the  majority 
hold  a  contrary  opinion.  The  signs  which 
were  considered  as  indicating  the  former  have 
been  proved  to  be  misleadii^g  and  fallacious. 
Thus  the  impulse  may  be  reduced  in  force  and 
extent,  the  first  sound  changed  in  its  character 
and  the  area  of  cardiac  dulness  lessened. 
Notwithstanding  all  these  signs  the  hyper- 
trophy still  remains  the  same,  and  the  apparent 
diminution  has  been  brought  about  about  by 
disgorgement  of  the  right  cavities. 

Walsh  says  that  the  theoretical  indication 
is  to  tranquilize  the  heart  by  diminishing  the 
quaii'.ity  without  deteriorating  the  quality  of 
the  blood.  For  this  purpose  he  recommends 
an  occasional  venesection  from  the  arm,  taking 
at  each  time  from  four  to  eight  ounces,  at  inter- 
vals of  from  two  to  six  weeks,  according  to  the 
robustness  of  the  patient.  Care,  howevtr, 
must  be  taken  not  to  induce  an  ansemic  condi- 
tion of  the  blood,  which  would  very  seriously 
aggravate  the  disease.  If  general  bleeding  is 
not  to  be  thought  of,  then  wet  cupping  should 
not  be  lost  sight  of.  Personally  I  have  met 
with  very  few  cases  of  the  disease  under  con- 
s'deration,  but  in  two  or  three  I  was  df  cidcdiy 
of  opinion  that  my  patients  were  much  bene- 
fiied  by  wetcup|)ing.  I  have  also  had  experi- 
ence of  the  benefit  of  a  half  dozen  leeches 
applied  over  the  cardiac  region  in  calming  the 
heart's  action.  We  do  not  possess  ai  y  drug 
capable  of  diminishing  the  bulk  of  the  heart. 
Iodide  of  potassium  has  betn  used  for  this  pur- 
pose, and  pushed  to  iodism  without  exhibiting 
any  such  power. 

Walsh  says  quietude  — physical,  emotional, 
intellectual — is  the  very  first  of  curative  agents 
for  an  enlarged  heart.  To  aid  in  tranquilizing 
it,  direct  cardiac  sedatives— hydrocyanic  acid, 
acetate  of  lead,  digitalis  and  belladonna  (the 
latter  both  internally  and  as  a  piaster  over  the 
heart,  which  latter  I  heartily  endorse),  must  be 
employed  during  the  entire  treatment  of  the 
case.  'J'here  must  be  occasional  intermissions. 
Aconite  he  also  strongly  recommended.  I  have 
given  it  in  the  form  of  Fleeming's  tii-,cture,  one 
drop  every  two  hours  till  its  effect  was  manifest. 
It  also  has  very  great  power  in  removing  those 
disagreeable  sensations  so  common  in  the 
pia^rai'dial  region.  Saline  and  aloetic  purga- 
ii\es  a'd  the  good  effects  of  rest,  and  diuretics 
are  useful,  independent  of  any  dropsy.  Unless 
the  patient  is  very  plethoric,  animal  food  in 
moderation  may  be  allowed — fish  under  all  cir- 
cumstances is  permissible.  Alcholic  liquors 
must  be  avoided  ;  any  fluid  taken  must  be 
limited.  Passive  open-air  exercise  is  to  be 
strongly  recommended. 

Page  says  digitalis  is  contra-indicated  as  a 


252 


THE   CANADA   MEDICAL   RECORD. 


rule,  unless  associated  with  a  mitral  lesion.  I 
Even  then,  if  ihe  heart's  action  is  very  forcible,  j 
it  may  be  omitted.  He  considers  aconite  as 
the  drug  of  most  value,  and  strongly  depre-  i 
cates  the  use  of  tobacco  and  alcohol.  A  course  , 
at  the  German  Spa,  Carlsbad,  he  has  found  j 
often  useful,  not  only  for  its  immediate  curative  j 
effect,  but  also  for  the  knowledge  one  learns  of  | 
how  to  take  care  of  oneself.  j 

Bartholow,  whose    faith   in    the    efficacy   of  I 
drugs  is  almost  unlimited,  says  that  he  has  met  J 
with  good  results  from  saline  purgatives,  which 
draw  off  considerable  fluid   from  the  intestinal 
canal.      He    has   also    used    veratrium   viride.   ! 
which  he  considers  more  powerful  but  not   so 
efficacious  as  aconite.     He  advises  the  potassa 
salts  sn  as  to  act  on  the  kidneys  and  thus  carry 
off  a  larger  amount  of  waste  material. 

Fagge  has  very  little  to  say  on  the  subject. 
In  fact  he  only  devotes  twenty-six  lines  to  it, 
in  which  lie  speaks  favorably  of  means  I  have 
already  mentioned,  and  adds,  "  Bromide  of  pot- 
ash is  mentioned  favorably." 

Our  distinguished  friend  and  late  fellow- 
member,  Dr.  Osier,  in  his  splendid  work  on 
practice,  enters  fully  into  the  treatment  of  hy- 
pertrophy with  valvular  disease,  dividing  his 
subjects  under  two  heads,  viz.,  (i)  stage  of 
compensation,  where  he  says  medicinal  treat- 
ment is  not  necessary  and  often  hurtful,  but 
lays  down  a  course  of  general  treatment  such 
as  I  have  already  mentioned ;  (2)  stage  of 
broken  compensation — i  nder  this  head  he 
speaks  strongly  of  the  benefits  to  be  derived 
from  rest,  and  illustrates  it  by  cases  he  met  with 
during  the  time  he  was  one  of  the  physicians 
of  the  Montreal  General  Hospital.  The  embar- 
rassed circulation,  he  says,  must  be  relieved. 
This  is  accomplished  by  venesection  and  deple- 
tion througli  ihe  bowels.  Those  remedies 
must  be  used  which  stimulate  the  heart's  action. 
1he  best  of  these  is  digitalis.  Broken  compen- 
sations, no  matter  what  the  valve  lesion  may  be, 
is  the  signal  for  its  use.  He  speaks  of  its  toxic 
effect  due  to  its  cumulative  action  and  sudden 
outbreak.  One  such  case  I  saw  when  the  resi- 
dent house  apothecary  during  my  student  days 
at  the  Montreal  General  Hospital.  Strophan- 
thus,  convallaria,  citrate  of  caffeine  and  Adonis 
vernalis  are  used,  and  I  liave  named  them  in 
the  order  of  their  value.  But  why  waste  time 
over  hypertrophy  with  valvular  disease  wlien 
our  time  has  been  occupied  in  discussing  hypcr- 
trojihy  without  valvular  disease  ?  1  reply,  be- 
cause the  treatment  of  each  is  much  alike.  In 
writing  of  our  special  subject  Dr.  Osier  says  : 
"The  treatment  of  iiypertrophy  and  dilatation 
has  already  been  considered  under  the  section 
on  valvular  lesions.  I  would  only  here  empha- 
size the  fact  that  with  signs  of  dilatation  as 
indicated  by  gallop  rhythm,  urgent  dyspncea 
and  slight  lividiiy,  venesection  is  in  many  cases 
tlie  only  means  by  which  the  life  of  the  patient 


may  be  saved,  and  from  20  to  30  ounces  of 
blood  shou'd  be  abstracted  without  delay. 
Subsequent'y  stimulants,  such  as  ammonia  and 
digital  s,  nny  be  administered." 

Dr.  Adolf  StrumpelJ  in  his  latest  work  on 
medicine  Fa)S  : 

"  The  treatment  of  idiopathic  cardiac  hyper- 
trophy is  precisely  the  same  as  for  valvular 
disease  and  myocarditis."  On  referring  to  the 
chapter  on  these  subjects  I  find  he  divides 
them  much  as  Oiler  has  done,  and  that  he  prac- 
tically discusses  the  same  remedies.  When 
compensation  has  be^n  established  Strumpell 
speaks  highly  of  baths.  He  says  they  are  not 
only  well  borne  by  cardiac  patients,  but  they 
exercise  a  peculiarly  beneficial  and  invig  irating 
influence  upon  tlie  action  of  the  heart.  Their 
temperature  should  be  from  90°  to  93^.  F. 

Dyspnoea  is  one  of  the  most  distressing 
symptoms  of  heart  disease.  Our  efforts  should, 
of  course,  be  directed  to  restoring  compen- 
sation. If  we  fail,  as  in  most  cases  we  will,  we 
must  then  treat  the  dyspnoea,  systematically. 
Morphia  is  most  efficient  in  this  respect.  It  is 
usually  well  borne,  and  gives  great  relief,  espe- 
cially it  it  be  given  hypodermically. 

There  are  certain  principles  which  apply 
more  or  less  to  all  cases  of  heart  disease,  and 
these  are  dwelt  upon  at  considerable  length  by 
Roberts.  General  management  is  always  a 
matter  of  much  usefulness.  If- occupation  is 
satisfactory  it  may  be  continued,  but  tlie  effect 
must  be  watched.  Oertel  has  written  favorably 
of  the  plan  of  treating  certain  lorms  of  heart 
disease  by  "  graduated  exercise."  In  carrying 
out  this  method,  the  i)atient  is  made  to  walk  up 
paths  of  gridual  ascent,  the  amount  of  exercise 
being  progressively  increased  as  the  patient  is 
able  to  bear  it.  .Special  treatment  in  the  form 
of  certain  gymiastic  exercises  is  also  advocated. 
Avoid  all  mental  disturbance.  Anxiety,  worry, 
mental  strain  or  excitement  in  connection  with 
pecuniary  matters,  business,  public  life  or  po- 
litics is  very  bad.  Avoid  anything  emotional, 
and  get  at  least  eight  hours  sleep.  As  regards 
medicinal  agents,  Roberts  says  :  ''  As  regards 
digitalis,  it  is  not  suitable  wiiere  there  is  mark- 
ed hypertro]:)hy."  Wiien  dilatation  is  also  |ire- 
sent  he  considers  it  a  valuable  remedy.  Nitro- 
glycerine is  recommended  in  cardiac  dyspnoea, 
especially  if  the  pulse  tension  is  high.  With 
regard  to  insomnia  or  disturbed  sleep  in  cardiac 
cases,  he  finds  stimulants  useful — chloric  ether, 
spiritus  ether  co.  and  spirits  of  camphor  of  ser- 
vice in  some  cases.  Opiates,  chloral  hydrate, 
especially  the  latter,  are  dangerous.  Paralde- 
hyde, sulphonal,  chloralanu'd  andurethane  are 
often  good  hypnotics.  It  is  of  great  importance 
,to  pay  attention  to  all  ihe  princiiial  organs  and, 
as  far  as  possi'ole,  prevent  them  from  becoming 
involveii,  especially  the  lungs,  kidneys,  liver  and 
digestive  organs  generally.  The  article  on  the 
heart   in   Pepper's  "  System   of  Medicine  "    is 


THE   CANADA   MEDICAL   RECORD. 


253 


by  Dr.  Osier.  It  says  :  The  treatment  of 
hypertrophy  consists  largely  of  measures  direct- 
ed towards  its  maintenance  to  a  degree  propor- 
tionate to  the  extra  work  which  the  heart  has 
to  do.  In  organic  disease  the  welfare  of  the 
patieiU  depends  on  this — we  cannot  remove 
the  cause,  but  we  can,  by  careful  hygienic  and 
dietetic  regulations,  maintain  the  balance  bet- 
ween the  defect  and  t'le  compensation.  The 
original  lesion  is  usually  beyond  control,  and 
the  special  indications  are  to  moderate  certain 
dangers  associated  with  hypertrophy  and  to 
promptly  meet  the  earliest  symptoms  of  heart 
failure.  In  the  hypertrophy  associated  with  arte- 
rial and  renal  disease,  a  special  danger  exists  in 
the  tendency  to  rupture  of  vessels.  In  these 
cases  a  vigorous  heart  beat,  with  a  very  high 
tension  in  the  peripheral  arteries,  indicates  mis- 
chief, which  may  be  met  by  taking  prompt  mea- 
sures for  the  reduction  of  the  high  pressure. 
A  brisk  cathartic  may  avert  an  attack  of  apo- 
plexy, and  there  are  cases  where  the  old  prac- 
tice of  bleeding — so  much  at  onetime  in  vogue 
for  hypertrophy — is  justifiable — might  I  add — 
more  than  justifiable.  Palpitation  and  short- 
ness of  breath  are  the  earliest  signs  of  failing 
compensation,  and  call  for  treatment,  in  which 
rest  is  a  very  im])Otant  factor, — in  fact,  in  many 
cases  is  all  that  is  required.  Within  the  past 
year  or  two  I  have  found  very  excellent  results 
in  cases  of  weak  or  dilated  heart  by  the  admin- 
istration of  pellets  of  cactina — one  every  two 
hours  during  the  day.  These  pellets  each  con- 
tain ^(-^  of  a  grain  of  cactina — the  active  proxi- 
mate ]jrinciple  of  Cactus  Mexicana.  My  friend, 
Dr.  Fuller,  of  Svveetsburg,  whom  I  saw  last 
summer  in  consultation,  told  me  that  his  exper- 
ience of  their  employment  had  been  very  satis- 
factory. I  have  also  lately,  to  a  slight  extent, 
used  as  a  cardiac  tonic  the  Kola  cordial  made 
by  Stearns,  of  Detroit,  and  while  my  expe- 
rience has  been  limited,  yet  I  am  satisfied  that 
it  is  an  excellent  cardiac  tonic.  It  accelerates 
the  pulsations  of  the  heart,  at  the  same  time 
increasing  its  power  and  regulating  its  con- 
tractions. It  also  has  a  diuretic  action.  In 
many  ways  its  action  resembles  digitalis,  but 
it  has  not  its  cumulative  action.  It  also  has  an 
invigorating  effect  on  the  general  system.  Thiss 
is  due  to  the  fact  that  it  contains  more  caffeine 
than  is  found  in  coffee,  and  an  equivalent 
amount  to  that  met  with  in  the  highest  grades 
of  tea.  It  also  contains  theobromine,  an  im- 
poitant  ingredient  in  cocoa.  It  thus  possesses 
the  properties  of  coffee,  tea  and  cocoa,  added 
to  a  peculiar  active  principle  of  its  own,  called 
"  Koianine,"  which  so  far  is  said  not  to  iiave 
been  found  in  any  other  vegetable  product. 
Strychnia,  either  in  pill  former  in  the  liq.  strych- 
nia, of  the  British  Pharmacopoeia,  or  hypoder- 
mically,  is  a  capital  tonic  to  the  muscles,  both 
voluntarily  and  involuntarily.  In  cardiac  dys- 
pnoea I  have  had  excellent  and  prompt  results 


from  the  application  of  an  ice  bag  over  the 
precordial  regions. 

Dr.  McCoNNELL  thought  the  point  insisted 
upon  by  Dr.  Adami,  that  all  the  changes  occur- 
ring in  cardiac  hypertrophy  were  the  result  of 
increased  tension,  was  the  essential  one  to  keep 
in  mind  in  considering  its  pathology.  There 
were  a  great  many  causes  which  might  bring 
about  increased  tension.  Dr.  Stewart  mention- 
ed many,  probably  most,  but  had  not,  he 
thought,  laid  sufficient  stress  upon  the  effect  of 
poisonous  substances  circulating  in  the  blood 
— the  result  of  improper  oxidation,  or  even  of 
bacterial  growth,  especially  in  the  gastro-intes- 
tinal  canal,  producing  auto-intoxication.  These 
often  were  the  most  important  factors  in  giving 
rise  to  increased  tension.  Arterio-sclerosis  and 
cardiac  hypertrophy,  as  for  instance  in  Bright's 
disease,  especially  that  form  known  as  "  con- 
tracted kidney,"  were  essential.  Angemia  and 
chlorosis.  Dr.  McConnell  thought,  were  also 
often  accompanied  by  hypertrophy  and  dilata- 
tion where  there  was  increased  tension.  They 
had  a  tendency  to  produce  increased  resistance 
in  the  peripheral  blood  vessels,  causing  hypertro- 
phy and  dilatation  of  the  heart,  the  latter  owing 
to  the  lessened  nutritive  qualities  of  its  blood 
supply.  Many  of  these  cases  seem  to  depend  on 
deficient  action  in  the  gastrointestinal  tractwith 
auto-intoxication,  and  the  increased  tension 
may  depend  on  changes  in  the  capillaries  and 
arterioles,  owing  to  the  glandular  functions  of 
these  endothelial  cells  being  exercised  in  elim- 
inating motbid  rnatter  from  the  blood.  In  the 
condition  called  lithtemia,  also,  the  products  of 
deranged  metabolism  led  to  increased  tension. 
It  was  almost  impossible,  he  believed,  to  sepa- 
rate dilatation  from  hy|iertrophy,  as  they  so 
often  occurred  together.  Lung  affections  also, 
emphysematous  conditions,  even  chronic  bron- 
chitis or  sclerotic  changes,  as  in  fibroid  phthisis, 
by  giving  the  right  heart  more  work  to  do, 
were  apt  to  cause  hypertrophy.  Even  obssity 
might  act  as  an  etiological  factor,  and  pheno- 
mena of  a  purely  neurotic  origin  often  tend  to 
bring  about  this  condition  He  had  a  case  of 
tachycardia  not  long  before,  in  which  the 
whole  trouble  seemed  to  be  of  a  neurotic  char- 
acter, and  it  became  almost  chronic  tachy- 
cardia. There  was  no  organic  trouble,  but  a 
certain  amount  of  hypertrophy  resulted,  tnen 
imperfect  compensation  followed,  succeeded 
by  heart  failure  and  death.  Dr.  McConnell 
thought  that  murmurs  following  relative  incom- 
petence might  be  mistaken  for  valvular  disease. 

Regarding  the  treatment,  he  believed  it  must 
vary  as  the  cause  varies.  S)mctimes  he  would 
lessen  the  action  of  the  heart,  sometimes  in- 
crease it,  but  the  most  important  feature  of  the 
treatment  was  likely  to  be  the  clearing  of  the 
blood  stream  of  all  poisonous  or  extraneous 
matters,  which  might  be  the  cause  of  increased 
tension  by  promoting   the  action   of  the   chief 


254 


THE  CANADA   MtUICAL   RECORD. 


emunctories  and  lessening  the  amount  of  fluid  in 
the  body.  Baths  play  an  important  part  in  this 
latter  respect.  A  recent  writer  who  studied  ihe 
action  of  baths  at  Naoheim, Germany,  in  vavular 
disease,  known  as  Schoit's  disease,  believed  they 
diminished  the  size  of  the  heart  by  peripheral 
dilatation  of  the  vessels,  besides  increasing  the 
sink  transudation.  Brine  baths,  ca-bonic  acid 
baths,  and  hot  balhs  were  ;;ll  emiiloyed  for  thi? 
effect.  The  patient  came  out  with  a  skin  as  red 
as  a  lobster,  and  the  area  of  hyper; rophy  and 
dilatation  as  determined  by  pcrcubsion  was 
i-om-.iimcs  reduced  as  much  as  one  inch  as  the 
result  of  a  single  bath. 

Dr.   FiNLEY  thought  too    much  stress  tiiight 
sometimes  be  laid   upon    arterial  sclerosis  as  a 
causative  factor    in  the  pro  iuction   of  cardiac 
hypertrophy;   that  it  might  sometimes  be  a  se- 
condary  rather   than  a   primary  condition,    al- 
though, with  the   sclerosis  once  established,  a 
vicious  cycle  was  set  up,  in  which  enlargement 
of  the  heart^^and  sclero-is  produced  and  kept  up 
each  other.*    He  believed,  however,  that  some 
cases  occurred  in  which  the  cardiac  trouble  was 
the  primary  one.     Cases  of  aortic  regurgitation 
were  not  uncommon  in  young  people  where  a 
considerable  degree  of  arterial  sclerosis  existed. 
In  Graves'  disease  Dr.  Adami  seemed  to  think 
that  the   enlargement  of  the  heart   was  due  lo 
increased  arterial  tension  ;  now,  in   these  cases 
the  arterial  tension  was  low.     It  seemed  to  Dr. 
Finley  that  the  cardiac  changes  that  occurred  in 
Graves  disease    might  be  the  result  of  the  in- 
creased work   thrown  on    the  heart   by  the  in- 
creased number  of  pulsations.  As  lo  the  symp- 
toms of  cardiac  hypei trophy,  one  may  say  there 
were  none.   It  was  when  dilatation  supervened 
or  when  compensation  was  defective  that  symp- 
toms occurred.  They  were,  of  course,  similar  to 
the  symptoms    following  mitral    disease  when 
compensation   was  failing.    All  kinds  of    pulse 
were  met  with  in  this  condition;  sometimes  weak 
and  irregular  like  the  advanced  stage  of  mitral 
stenosis  ;  sometime?  in  paits,  one  weak  aiidone 
strong  :  and  the  few  cases  of  brachycardia  and 
tachycardia  seen  by  Dr.  Finley  were  associated 
with  this  condition.   He  regretted  that  physio- 
logy had  not  been  able  to  do  more  to  clear  up 
this    subject ;  so  far,  experimental   work    had 
thiown  very  little  light  on  the  irregularity  of  tne 
pulse.  Touching  the  treatment,  he  believed  ii  a 
good  rule  to  divide  the  cases  into  two  classes  : 
(t)  those  of  high  tension,  (2)  those  of  low  ten- 
sion. In  the  first  the  object  should  be  to  decrease 
tension,  and  iodide  of  potassium  was  often  very 
useful  in  relieving  distressful  attacks  of  palpita- 
tion ;  nilro-gljcerine    had  its    uses,  and  purga- 
tives, especially  mercurial,  followed  by  a  saline 
in  the  morning,  were  of  very  considerable  value. 
For  the  purpose  of  relieving  sleep  and  distress- 
ing dyspnoea,  nothing  equalled  morphia,      l  he 
other    hypnotics,  such  as    sulphonal,    chloral, 
paraldehyde,  often  failed.     In  the  second  class 


attention  should  be  directed  towards  strengthen- 
ing the  heart  and  giving  the  ordinary  cardiac 
tonics. 

Dr.  LAFLtiUR,  seeing    that   Dr.  Stewart    had 
exhausted  the  etiology  of   liie  subject,  would 
content  himself  with  reading  a  tabular  state- 
ment of  cardiac  hypertrophy  in  general.     It  was 
i   based  as  follows:   (i)  Causes  within  the  heart  : 
'   these  were    practically  two  :    (a)   myocarditis, 
I  however  induced,  either  sclerotic,  or  that  which 
is   the  result  of  chronic  pericardial  inflamma- 
[  tion  ;  {b)  aneurisms,  which  by  weakening  one 

■  poriion  produced  hypertrophy  in  others.  (2) 
The  second  great  division  included  causes  out- 
side the  heart;  among  these  weie  noted:   (a) 

i  purely  mechanical  causes,  and  of  these  the  pria- 
'  cipal  and  only  one  was  in  reality  adhesion  of  the 
i  pericardium,  synechia  pericardii,  which  might 
I  or  might  not  be  combined  with  pleural  adhe- 
'  sion  ;  (/;)  a  great  number  of  causes  which  de- 
pended   upon    the    raising    of  blood  pressure. 

■  Here  the  distinction  might  be  made  of  blood 
i  pressure  raised  in  territorial  areas,  or  a  general 
j  increase  of  blood  pressure ;  among  the  former 
]  were  chronic  or  subacute  nephritis,  ch ionic 
I  pulmonary  diseases,  chronic  bronchitis,  sclero- 
sis   of    the    lung,   and    true    chronic    fibroid 

I  phthisis.  Still  dealing  with  territorial  laising 
of  blood  pressure,  we  had  the  pressure  of 
tumors  upon  large  vascular  trunks  (quite  a 
rare  cause,  but  it  might  occur  in  mediastinal 
disease).  Then  the  general  raising  of  blood 
pressure,  as  brought  about  by  poisons  of 
various  kinds  ;  by  excessive  manual  labor  ^ 
nervous  derangements  ;  and  arterial  sclerosis. 
(3)  Hasmic  plethora.  This  was  not  infre- 
quently combined  with  arterial  hypoplasia.  Dr. 
Lafleur  remarked  he  had  access  to  some  statis- 
tics which  showed  the  proportion  in  which  these 
various  causes  come  into  effect,  drawn  from 
360  autopsies  repiesenting  the  total  number 
of  autO|)sies  from  the  opening  of  the  Johns 
Hopkins  Hospital,  May,  1889,  to  April,  1893. 
In  360  autopsies,  cardiac  hypertrophy,  due  to 
some  cause  or  other,  was  found  to  exist  in 
no  less  than  105  cases.  Of  these,  artejial  sclero- 
sis was  found  to  be  the  cause  in  59%  ;  chronic 
ne^jhritis  in  13.4%  ;  valvular  lesions,  12.4%;  adhe- 
sions of  the  jjericardium  in  7.6%  ;  excessive 
muscular  work  in  3.8%  ;  tumors,  1.9%  ;  aneur- 
isn.s  in  0.95%  ;  haemic  plethora  in  0.95%.  It 
wa'i  seen  from  this  paper  that  more  than  50% 
of  the  cases  of  cardiac  hypertrophy  in  general 
hospital  work  was  due  to  arterial  disease.  The 
frequency  therefore  of  arterial  scleiosis  had 
certainly  been  underestimated.  The  speaker 
knew  it  to  be  extremely  common  in  the  United 
States,  and,  from  all  reports,  it  was  so  upon 
the  continent  of  Europe.  FHle  agr.  ed  with  Dr. 
Adami  that  dilatation,  in  the  vast  majority  of 
cases,  accomj^anied  hypertrophy.  Conceniiic 
hypertrophy  was  almost  always  a  post-mortem 
change.     An    (ibserver  (Corvisart),  during  the 


THE  CANADA  MEDICAL  RECORD. 


255 


time  of  the  "  reign  of  terror"  in  France,  records 
that  persons  guillotined  were  noticed  in  the 
post-mortem  rooms  to  have  firmer  contracted 
hearts  with  small  cavities,  showing  that  the 
apparent  thickening  of  the  wall  was  due  tu 
strong  rigor  mortis.  Dr.  Lafleur  wished  to 
know  if  he  had  understood  Dr.  Adimi  rightly 
when  he  stated  that  in  general  arterial  scleiosis 
the  connective  tissue  change  in  the  intima  was 
the  initial  point  ?  He,  himself,  had  been  accus- 
tomed to  consider  that  the  essential  primary 
condition  was  a  degeneration  of  the  media,  and 
that  the  connective  tissue  change  was  really  a 
reparative  process,  such  as  was  seen  in  all 
cases  of  sclerosis.  This  latter,  at  all  eveiits, 
was  the  view  of  Councilman  and  I'homa. 
The  vicious  circle,  alluded  to,  was  especially 
marked  in  those  cases  of  arterial  sclerosis 
accompanied  with  hypertrophy  ;  why  it  should 
be  particularly  so  in  general  arterial  sclerosis 
was  easily  understood  when  we  considered  the 
enormous  number  of  vessels  involved.  Not 
only  the  systemic,  but  the  pulmonary  circula- 
tion was  affected  in  these  cases,  and  the  disease 
of  the  latter  reacted  on  the  right  heart  just  as 
that  of  the  former  did  on  the  left.  The  prog- 
nosis was  especially  bad  in  cardiachypertrophy 
with  dilatation  when  it  occurred  in  cases  of  gen- 
eral arterial  sclerosis.  Dr.  Lafleur  remarked  in 
connection  with  the  treatment,  that  he  thought 
Dr.  Campbell  shoitld  have  been  justified  in  pro- 
testing when  asked  to  discuss  the  treatment  of 
cardiac  hypertrophy,  because,  after  all,  hyper- 
trophy was  a  conservative  process,  and  there- 
fore beneficial.  Allusion  was. made  to  Oertel's 
treatment  of  hypei  trophy.  That  treatment  had 
not  found  the  favor  here  that  it  had  in  the 
Old  Country.  Some  very  stringent  remarks 
have  been  passed  upon  it.  One  writer  declared 
that  a  large  number  of  people  who  have  not 
cardiac  disease  will  be  cured  by  it,  and  the  few 
who  followed  it,  and  really  have  the  disease, 
will  be  killed.  The  speaker  wij^hed  to  add  his 
testimony  in  favor  of  local  and  general  bleeding 
in  cases  of  hypertrophy  from  arterial  disease. 
That  and  hydragogue  purgatives  were  the  only 
means  we  had.  He  had  seen  one  case  where 
bleeding  certainly  saved  the  man's  life.  The 
man  was  completely  comatose,  and  was  rapidly 
approaching  his  end,  when  he  had  him  bled  to 
the  extent  of  18  ounces  ;  he  was  at  work  upon 
his  farm  two  months  later. 

Dr.  Blackader,  in  considering  the  treatment 
of  the  various  forms  of  cardiac  hypertrophy, 
held  that  much  importance  must  always  be 
given  to  the  etiology  ;  without  clear  ideas  on 
this  point  we  would  certainly  fail  to  obtain  all 
the  relief  for  our  patient  which  was  practicable. 
In  some  cases  temporary  rest  of  the  body  in 
the  recumbent  position  formed  an  important 
therapeutic  measure.  We  secured  for  the  heart 
a  comparative  rest,  also,  by  limiting  the  amount 
of  fluids    taken  into  the    stomach,  and  in   this 


way  lessening  the  amount  absorbed,  and  the 
total  volume  of  blood  to  be  moved.  In  the  dis- 
eases of  no  other  organ  would  a  due  consider- 
ation of  ordinary  physical  laws  give  so  much 
asr^istance  in  treatment,  in  another  series  of 
cases,  disturbed  innervation  seemed  to  play  an 
important  role,  either  affecting  the  cardiac 
nerves  and  producing  over-action,  or  acting  on 
the  minute  arterioles,  producing  an  increase  in 
arterial  tension,  and  thus  adding  to  the  work 
of  the  heart.  Such  cases  might  receive  much 
benefit  from  the  careful  use  of  nerve  sedatives, 
such  as  the  bromides,  or  chloral  hydrate.  Both 
these  drugs,  but  especially  the  latter,  had  a  di- 
rect action  on  the  cardiac  and  vasomotor  nerves, 
wnile  at  the  same  time  they  overcame  the  in- 
somnia and  general  restlessness  which  in  many 
cases  were  prominent  features. 

While  recognizing  fully  the  value  of  the  var- 
ious therapeutic  measures  mentioned  by  Dr. 
Campbell  for  the  relief  of  the  later  stages  of  the 
disease,  when  we  had  to  deal  with  a  failing 
heart,  Dr.  Blackader  thought  that  attention  had 
not  been  sufficiently  called  to  the  necessity  of 
recognizing  and  treating  the  earliest  condition 
in  which  there  was  a  pure  hypertrophy  of  the 
heart  muscle.  For  treatment  such  cases  might 
be  grouped  into  two  classes  :  (i)  those  in  which 
the  chief  trou'ble,  for  the  time  being,  lay  in  over- 
action  of  the  heart  muscle  ;  (2)  those  in  which 
the  principal  difficulty  was  undue  contraction 
of  the  arterioles.  And  to  meet  these  conditions 
we  had  two  drugs  which  would,  properly  em- 
ployed, give  efficient  assistance.  The  first  was 
aconite,  which  acted  directly  on  the  heart,  less- 
ening its  force  and  frequency,  and  had  compara- 
tively little  action  on  the  vascular  system.  The 
second  was  a  solution  of  either  sodium  nitrite 
or  nitro-glycerine.  Both  of  these  acted  directly 
upon  the  small  arterial  vessels,  and  had  almost 
no  action  upon  the  heart,  and  by  them  arteiial 
tension  could  be  lessened.  If  good  results  were, 
however,  to  be  obtained,  it  was  necessary  to  se- 
cure a  steady  action  of  the  drug,  paying  due 
regard  to  the  tirne  required  in  its  elimination. 
Aconite  was  eliminated  conijjaratively  slowly, 
and  in  order  to  maintain  an  even  action  it 
should  be  administered  about  every  six  hours  ; 
with  the  nitrites  it  was  different,  they  were  elim- 
inated rapidly,  and  to  maintain  their  action  in 
the  vessels  the  dose  should  be  repeated  at  least 
every  three  hours.  The  ordinary  routine  me- 
thod of  administering  them  two  or  three  times 
a  day  was  very  defective,  and  in  most  cases 
proved  useless. 

Dr.  WiLKiNS  mentioned  a  case  which 
occurred  recently  in  his  practice,  which  tended 
to  establish  high  arterial  tension  as  the  cause 
of  cardiac  hypertrophy.  The  woman  had  been 
under  his  care  for  the  last  three  years.  She  first 
complained  of  difficulty  of  breathing  on  the 
slightest  exertion.  Examination  showed  the 
lungs  normal,  slight  enlargement  of  the  heart, 


256 


THE   CANADA   MEDICAL   RECORD. 


with  increased  accentuation  of  the  second  -jortic 
sound.  This  led  him  to  examine  tlie  urine.  He 
found  there  sometimes  slight  traces  ufaibumen, 
at  other  times  albumen  was  entirely  absent,  but 
the  urine  was  always  of  low  specific  gravity. 
During  the  last  few  months  she  suffered  in- 
tensely from  agonizing  paroxysms  of  shortness 
of  breath.  They  would  seize  her  in  bed,  the 
face  become  pallid,  the  limbs  culd,  yet  notwith- 
standing this  the  pulse  was  one  of  high  arterial 
tension.  Examining  the  lungs  during  these 
paroxysms,  breathing  sounds  were  at  first  nor- 
mal, later  on  some  few  rales  might  be  heard, 
but  at  no  time  sufficient  to  account  for  the  dys- 
pnoea. One  naturally  inquired  what  could  be 
the  cause  of  the  dyspnaa.  He  thought  it  must 
be  due  to  a  spasmodic  condition  of  the  pulmo- 
nary vessels,  and  this  spasm  was  an  indication 
of  the  condition  of  the  vessels  throughout  the 
rest  of  the  body.  The  spasm  must  be  the 
result  of  some  poison  circulating  in  the  blood. 
Alieady  medical  men  were  discussing  the  nature 
of  this  poison.  Bright,  when  treating  of  kidney 
disease  spoke  of  the  enlargement  of  (he  heart 
which  was  ])rescnt  in  many  cases.  Some  few 
years  later  Dr.  George  Johnson,  of  King's  Col- 
lege, wrote  a  very  interesting  article  upon  this 
condition  of  thickening  of  the  coats  of  the  ves- 
sels in  kidney  disease,  and  described  it  as  one 
of  hypertrophy  of  the  muscular  coat.  He 
thought  the  hyperirophy  was  due  to  the  thick- 
ering  of  the  capillaries  which  supplied  nourish- 
ment to  the  body.  Then  came  the  demonstra- 
tions of  Brown-Sequard  and  Claude  Bernard. 
Johnson  afterwards  recanted  his  opinion  as  to 
the  hypertrophy  being  due  to  obstruction  in 
the  capillaries  ;  he  then  thought  it  to  be  due  to 
a  spasmodic  condition  of  the  muscles  of  the 
blood  vessels,  wh.ch  contracted  with  a  view  to 
prevent  impure  blood  from  passing  into  the 
tissues.  Now,  this  latter  theory  would  account, 
Dr.  Wilkins  believed,  for  the  conditions  pre- 
sent in  his  patient.  That  there  was  a  spasm 
there  could  be  no  doubt,  but  the  cause  of  the 
spasm  might  be  a  question — whether  it  was  a 
reflex  or  a  contraction  induced  by  the  direct 
contact  of  an  irritant  upon  the  muscles  of  the 
i^esscls,  was  a  subject  still  under  dispute.  M<jst 
auliionlijs  at  the  present  day  were  inclined  to 
believe  that  the  Llool  itself  acted  directly  upon 
the  muscular  substance  of  the  coats  of  the  arte- 
ries, and  in  that  way  prevented  the  passage 
through  of  the  blood  containing  pois>jn.  Gas- 
kell  wrote  an  article  upon  the  influence  of  irri- 
tants upon  the  muscular  substance  of  the  ves- 
sels and  the  heart  ;  and  he  said  that  it  was  not 
necessary  for  the  nervous  system  to  be  con 
necied  with  tiie  uuiacles  in  order  to  produce 
rhythmical  contraction  of  the  coals.  An  appa- 
rent objection  to  this  theory  was  the  fact  that 
one  would  sometimes  see  spasms  of  the  muscu 
lar  coat  producing  epileptiform  convulsions  in 
one  person  and  in   another  some  different  con- 


dition ;  and  again,  if  these  irritating  materials 
were  all  the  time  circ  dating,  why  were  not  the 
spasms  continual  ?  That  was  explained  by  the 
fact  that  in  the  body  are  found  poisons  of 
directly  antagonizing  effects.  A  couple  of 
years  ago  a  murder  trial  had  taken  place  in 
New  York,  in  which  some  expert  demonstrated 
the  presence  of  morplua  salts  in  the  blood  or 
stomach,  and  Dr.  Vaughan,  of  Ann  Harbor, 
was  able  to.  prove  in  court  that  sul)Stances 
could  be  obtained  from  the  body  having  the 
same  action  as  that  of  morphia,  and  that  it  was 
impossible  to  distinguish  between  the  reactions 
of  some  of  ihes^  poisons  derived  from  the  body 
and  those  of  morphia.  Some  recent  observers 
mentioned  that  poisons  of  an  irritating  nature 
could  be  obtained  from  the  urine,  which  poi- 
sons were  capable  of  producing  tonic  seizures. 
They  said  even  that  morning  urine  would  give 
poisons  differing  from  those  of  the  urine  of  the 
evening.  Considering  aM  this,  it  did  not  take 
much  to  make  one  believe  the  possibility  of 
poisons  existing  in  the  body  which  were  able  to 
produce  a  narcotic  ac'.ion  at  one  time  and  at 
another  time  a  spasmodic  action,  or  at  one  time 
the  coma  of  kidney  disease  and  at  another  the 
spasms  of  such  conditions  as  were  under  dis- 
cussion. In  the  vegetable  kingdom  die  poppy 
]).oduced  medicines  which  were  narcotic,  and 
also  medicines  which  were  tetanic  in  their 
effects.  It  therefore  required  but  little  stretch 
of  the  imagination  to  believe  that  the  blood 
contained  materials  which  at  one  time  might 
produce  tonic  spasmodic  effects  and  at  another 
time  the  opposite  condition.  For  treatment, 
he  believed  in  cases  of  kidney  trouble  the  great 
thing  was  to  lower  die  tension.  Many  cases 
would  be  found  in  which  all  treatment  failed  to 
reduce  the  quantity  of  albumen  in  the  urine 
until  the  arterial  tension  was  lowered,  and  the 
moment  that  was  eflected  the  albumen  dim- 
inished, the  pulse  improved  and  recovery  super- 
vened. On  the  other  hand,  in  a  case  where 
the  tension  remained  high  (somewhat  acute 
cases  with  large  kidneys),  even  though  the 
albumen  diminished,  the  course  was  lively  to 
be  towards  chronic  Bright's  disease. 

Dr".  Mills  said  that  Dr.  Lafleur  and  Dr. 
Finle\  in  their  remarks  had  ajiparently  assumed 
that  ihe  condition  of  the  arteries  in  the  lungs 
migiit  be  the  same  as  in  other  parts  of  the 
body.  A  recent  discovery  in  physiology  was 
of  prime  importance  to  the  subject  under  dis- 
cussion—that  is,  that  the  vessels  of  the  lungs 
were  innervated  like  the  systemic  arterioles. 
This  discovery  explained  wh}  the  right  heait 
was  invariably  found  full  and  dist  nded  in 
as|)hyxia,  while  the  left  was  empty  an  I  con- 
tracted. If  contraction  of  tlie  pulmonary  anc- 
rioles  was  assumed,  it  was  easily  under>tood 
why  these  phenomena  occurred.  Dr.  Mills 
thought  that  the  i)resent  views  held  with  regard 
to  the  nature   of  blood   pressure  were   far  too 


THE   CANADA   MEDICAL   RECORD. 


257 


simple  and  would  liave  to  be  modified  in  favor 
of  some  more  complex  theory.  He  thought 
blood  pressure  could  no  longer  be  regarded  as 
the  mean  result  of  the  cardiac  impulse  and  peri- 
pheral resistance. 


firo^ccBS    of   ^crciicc* 


UNILATERAL  SWEATING    IN    TUBER- 
CULOSIS. 

A.  Zechanowitsch  observed  a  case  of  phthisis 
in  which  there  was  abundant  perspiration  of 
the  right  side  of  the  face  and  of  the  right  tem- 
ple, while  the  left  side  was  perfectly  dry. 
Another  interesting  feature  was  that  the  tuber- 
culous process  was  confined  to  the  right  hing, 
while  the  laryngeal  manifestations  alsoapj^eared 
on  the  right  side. — Medic iiia,  No.  ir,  1894; 
St.  Petcrsburgcr  iiicd.  Woc/wNschriff,  June  9, 
1894. 

PERINEPHRITIC  ABSCESS.* 
By  John  M.  Foster,  M.D.,  Richmond,  Ky. 

Having  had  the  privilege  of  operating  upon 
four  cases  of  the  above  named  trouble,  through 
the  courtesy  of  some  of  my  fellow-physicians, 
and  having  found  the  literature  rather  meager 
on  the  subject,  I  take  this  opportunity  of  call- 
ing your  attention  to  some  observations  which 
may  be  helpful. 

As  you  are  aware,  the  disease  is  comparatively 
rare,  the  diagnosis  at  times  obscure,  and  the 
mortality  very  much  increased  by  lateness  in 
resorting  to  operative  procedure.  Since  the 
four  cases  coming  under  my  observation  were 
quite  similar,  they  will  be  discussed  as  a  whole 
and  not  seriatim. 

There  were  present  in  these  cases  certain 
symptoms  which  are  not  spoken  of  in  the 
text-books  and  journals  at  my  disposal. 

With  regard  to  the  cause,  I  would  say  that  all 
four  of  these  cases  were  caused  by  sudden  chill- 
ing of  the  body  after  exertion,  although  this 
cause  is  not  mentioned  by  some  writers,  and  is 
spoken  of  as  infrequent  by  others. 

With  regard  to  symptoms,  I  did  not  find 
them  typical  nor  well  defined  by  any  means. 
In  all  the  cases  the  greatest  pain  and  tender- 
ness were  found  over  the  lower  edge  of  the  liver, 
in  two  in  the  axillary  line,  and  in  the  other  two 
anterior  to  this  line,  so  that  at  first  in  two  of  the 
cases  the  liver  was  suspected  for  several  days 
as  being  the  seat  of  the  trouble.  In  two  of  the 
cases  the  pain  was  severe,  in  the  other  two  it 


*  Synopsis  of  a  paper  reatl  before  the   Southeastern  Kyii. 
tncky  Medical  Society  at  Livingston,  Kentuclvy. 


was  unimportant.  There  was  an  absence  of 
chills  and  rigors  which  we  are  accustomed  to 
expect  in  su[jpiirative  processes,  and  the  fluctua- 
tion of  the  temperature  resembled  a  mild  remit- 
tent malarial  fever.  There  was  also  an  absence 
of  swelling,  oedema  and  redness  which  is  found 
in  a  more  superficial  abscess.  No  tumor 
could  be  felt  nor  could  deep-seated  fluctuation 
be  elicited,  the  latter  symptom,  however,  being 
very  deceptive  at   best. 

The  most  prominent  symptom,  and  one 
whicli  I  have  not  seen  mentioned  in  any  text- 
book, yet  one  which  I  consider  almost  pathog- 
nomic, was  an  approximation  of  the  last  rib 
coward  the  crest  of  the  ileum,  conjoined  with  a 
feeling  of  fullness  and  resistance  in  the  flank  of 
the  aff'ected  side,  although  the  body  would 
appear  to  be  in  a  straight  line.  This  approx- 
imation of  the  rib  toward  the  ileum  could  only 
be  detected  by  deep  pressure  in  the  flank  with 
the  fingers.  While  the  space  of  three  or  four 
fingers  could  be  found  on  the  unaffected  side  in 
the  flank  between  the  crest  of  the  ileum  and 
last  rib,  the  space  of  only  one  or  two  fingers 
could  be  found  on  the  affected  side.  Flexion 
of  the  leg  was  absent  in  one  case. 

An  operation  should  be  done  early,  and  if 
there  is  doubt  about  the  diagnosis,  an  aspirating 
needle  can  be  used  to  determine  the  presence 
of  pus.  Dr.  H.  W.  Bowditch,  who  has  reported 
ten  cases  of  this  trouble,  says:  "  If  ever  there 
be  occasion  for  cautious  boldness  on  the  part  of 
the  surgeon,  these  abscesses  present  them." 

In  the  choice  of  a  site  for  operating,  this 
must  often  be  decided  by  the  individual  case , 
for  there  is  generally  some  one  point  in  the 
lumbar  region  of  each  case,  which  is  the  most 
favorable  for  reaching  the  pus.  Generally 
speaking,  a  point  one  and  one-half  inches  above 
the  crest  of  the  ileum,  along  the  anterior  bor- 
der of  the  quadratus  lumborum,  is  a  favorable 
point.  The  incision  or  puncture  being  made 
in  the  direction  of  the  kidney,  an  oblique  in- 
cision is  less  likely  to  come  in  contact  with  im- 
portant blood  vessels.  If  the  case  is  a  recent 
one  and  the  patient  of  average  flesh,  you  need 
not  be  surprised  at  going  from  three  to  four 
inches  in  depth  before  reaching  the  pus.  This 
should  be  evacuated  by  a  free  incision,  unless 
you  prefer  to  make  a  small  incision  which  can 
be  enlarged  by  inserting  a  pair  of  stout  forceps 
or  scissors,  which  on  being  withdrawn  with  the 
blades  open  will  enlarge  the  opening  without 
risk  of  hemorrhage.  After  the  insertion  of  a 
large  drainage  lube  and  washing  out  the  cavity 
with  peroxide  of  hydrogen,  the  case  is  to  be 
treated  on  general  surgical  principles. 

The  ages  of  the  patients  coming  under  my 
care  were  from  16  to  45  years.  They  were 
operated  on  from  two  to  four  weeks  after  the 
development  of  the  first  symptoms;  the  suppura- 
tion continued  from  one  to  five  weeks.  All 
ritcoYQXQ^.-lNternational  Journal  of  Surgery. 


258 


THE   CANADA   MEDICAL   RECORD. 


TREATMENT  OF  EMPYEMA. 

The  method  recommended  by  Dr.  J.Michael 
consists  in  establishing  two  openings  in  the 
thorax,  in  front  and  behind,  so  as  to  permit 
simultaneously  of  outflow  of  pus  and  injection 
of  fluid  into  the  pleural  cavity.  In  desperate 
cases  where  the  evacuation  of  a  large  quantity 
of  pus  would  give  rise  to  serious  symptoms 
owing  to  the  diminution  of  intra-thoracic  pres- 
sure, this  method  has  been  found  of  great  ser- 
vice. During  evacuation  of  pus  the  bulging 
intercostal  spaces  should  be  closely  inspected, 
and  as  soon  as  they  are  seen  to  become  de- 
pressed, the  fluid  (chlorinated  water,  or  dis- 
tilled water  with  addition  of  tincture  of  iodine, 
15  drops  to  I  litre)  is  introduced  into  the 
pleural  cavity  with  an  irrigator.  This  proce- 
dure is  kept  up  until  clear  water,  free  from  pus, 
flows  from  the  anterior  opening.  In  a  case 
treated  by  Michael,  a  cure  resulted  after  three 
perrigations,  as  he  terms  this  method. —  Therap. 
Monatsh,Jafi.,  1895. 

FISTULA  IN  A  NO. 

In  doing  a  radical  operation  for  fistula,  the 
following  points,  according  to  Dr.  J.  H.  Bacon, 
should  be  observed  : 

1.  Never  sever  the  sphincters  at  more  than 
one  place  at  the  same  operation,  no  matter 
what  the  complications  may  be,  otherwise  in- 
continence is  sure  to  follow. 

2.  Unless  all  the  channels  are  followed  up  and 
laid  open,  the  operation  will  fail  of  its  purpose. 

3.  Fistula  resulting  from  tubercular  abscess 
must  not  be  operated  upon  if  there  is  sufficient 
tissue  destruction  of  lung  to  produce  hectic 
fever,  sweats,  etc.,  unless  the  fistula  is  causing 
severe  painful  spasms  of  the  sphincters,  then  it 
should  be  divided  at  any  stage. 

4.  After  laying  the  fistula  tract  open,  the 
wound  must  be  made  to  heal  from  the  bottom, 
and  as  the  cutaneous  or  mucous  side  of  the 
wound  is  better  nourished,  it  will  throw  out  a 
more  healthy  granulation,  that  tends  to  bridge 
over  and  close  the  slower  granular  surface  at 
the  bottom,  thus  leaving  a  fistula  remaining. 

5.  When  the  fistulous  tract  is  not  too  com- 
plicated it  should  be  dissected  out  entire  and 
the  wound  brought  together,  beginning  at  the 
bottom  with  continuous  catgut  sutures  and 
approximating  the  surfaces  in  successive  layers 
until  the  whole  wound  is  closed. — No  it  Inn . 
Medical  Journal . 

TREATMENT    OF    SOME    FREQUENT 
MALADIES  OF  CHILDREN. 

Atueniia. — First,  attention  should  be  paid 
to  hygiene  and  to  regular  feeding  with  nourish- 
ing and  easily  assimilable  foods.  Correct  all 
intestinal   disturbances.     Before    each  feeding 


administer  the  syrup  of  the  iodide  of  iron  for 
fifteen  days,  followed  for  the  next  fifteen  days 
by  Fowler's  solution,  commencing  with  J^  drop 
for  a  child  of  two  years. 

From  time  to  time  suspend  this  treatment 
for  a  week,  and  give — 

Syrup  of  rhubarb, 
Syrup  of  gentian,  of  each,  f^iv. 
Dessertspoonful  for  each  dose. 

Or  of  the  following  : 

Tr.  nux  vomica,  tt^xv; 
Tr.  anise, 
Tr.  gentian, 
Tr.   cascarilla, 

Tr.  Colombo,  of  each,  f.^i,  njjxv. 
Dose — From  5  to  10  drops. 
If  there  is  indigestion,  administer  after  meals 
a  small  glass  of  this  lemonade  : 

Acid  hydrochloric,  iijixv; 
Syrup  of  lemon,  f.^iii  ; 
Distilled  water,  Oi. 
If  there  are  symptoms  of  rachitis,  phosphated 
milk,  phosphate    of  lime,  or  acid  phosphate   of 
lime  in  milk   may  be  added  to  the  above  reg  - 
men,    while  stronger   feeding  also   may   be  re- 
sorted to. 

For  aneemia  with  scrofulosis,  cod-liver  oil  in 
winter  and  syrup  of  the  iodides  in  summer 
should  be  administered. 

Syrup  of  the  iodide  of  iron  may  be  alter- 
nated wiih  Fowler's  solution  at  the  same  time 
that  the  oil  is  being  given. 

If  there  are  symptoms  of  tuberculosis,  to  the 
foregoing  treatment  add  this  plan  : 
Upon  a  plate  pour  a  mixture  of — 
Tar,  5iiss  ; 
Creosote,  ^iii  to  ovi, 
and  place  over  a  night-lamp  burning  throughout 
the  night  in  the  sleeping-room  of  the  infant. 

Aiicemia  of  Syphilitics. — To  the  new-born 
give  frequent  small  doses  of  mercury,  and  in- 
crease the  dose  ;  if  the  child  is  too  feeble  the 
medicine  can  be  given  by  inunctions. 

For  anaemia  following  malaria,  administer 
wine.of  cinchona  in  doses  from  a  coffee-spoonful 
to  a  soup-spoonful  before  meals  for  fifteen  days  ; 
then  for  the  next  fifteen  days  Fowler's  solution, 
I  to  3  drops. 

In  haemophilia  or  anaemia  from  loss  of  blood, 
for  the  first  few  hours  i  to  2  drops  of  per- 
chloride  of  iron  every  two  hours,  then  three  or 
four  times  a  day. 

For  constipation  at  weaning-lime,  injections 
and  glycerin  suppositories,  and  before  mea  a 
spoonful  of — 

Syrup  of  rhubarb, 
,      Syrup  of  gentian,  of  each,  equal  parts. 
Or   give  every  morning  a  cofTee-spoonful  of — 
Olei  ricini. 
Syrup  of  orange  flowers,  of  each,  f5ss. 


THE   CANADA   MEDICAL   RECORD. 


259 


Also,  in  the  same  dose, — 

Calcined  magnesia, 
Sulphur,  sublimed, 
Cream  of  tartar,  of  each,  ^i ; 
Essence  of  anise^  ti^iiss. 
When  the  liver  is  sluggish,  in  the    morning, 
once    or  twice  a   week,  give  the   following  in 
cachet,  or  in  honey,  or  sugar  water : 
Calomel, 

Scammony,  of  each,  gr.  iii.  to  gr.  v. 
For  a  purgative  : 

Boiling  water,  f.^iii ; 
Manna  in  tears,  (51; 
Senna  leaves,  ^i ; 
Powder  of  parched  coffee,  3iiss. 
Strain,  and  take  during  the   day. 
With  atony  of  the  intestines  : 
Tr.  nux  vomica,  f^ss  ; 
Tr.  belladonna, 
Tr.  anise, 

Tr.  cascara,  of  each,  f^iiss. 
Given  in  water  (8  to  12  drops)  before  meals. 
For  biliary  calculus  in  infants,    in  the  inter- 
vals, bicarbonate  of  sodium   in  grain  doses  for 
ten  days.     The  following  ten  days, — 
Syrup  of  ether, 

Syrup  of  turpentine,  of  each,  (3m. 
A  dessertspoonful  before  meals. 
Twice  a  week   add  to    the  above  a  coffee- 
spoonful  of — 

Sulphur,  sublimated, 
Cream  of  tartar, 
Magnesia,  of  each,  ^v  ; 
Essence  of  anise,  n)jxv. 
Before  meals. 
The  following  table  of  foods  may  prove  use- 
ful : 

Foods  permitted. — Milk,  cream,  and  fresh 
cheese;  soups,  eggs  ;  all  meats  in  small  quanti- 
ties, especially  chicken  ;  legumes,  well  cooked 
and  when  green  ;  potatoes  ;  dried  fruits,  prefer- 
ably cooked  ;  marmalades  and  jams  ;  cooked 
fish  ;  bread  in  small  quantity  ;  alkaline  waters. 
Foods  not  permitted. — Butter  and  fats,  old 
cheese,  pork,  mushrooms  and  truffles,  pastries 
and  sweetmeats,  dried  legumes,  sausages,  as- 
paragus and  tomatoes,  liquors,  coffee,  wines, 
and  strong  beers. 

For  Nephritic  Colic. — Hot  baths,  afterwards 
blisters,  hot  poultices,  or  hot  fomentations  or 
stupes  applied  over  the  renal  region  ;  then  ad- 
minister every  half-hour  a  dessertspoonful  of 
the  following  mixture  : 

Antipyrin,  gr.  viii.  to  gr.  xv  ; 
Chloroform  water,  fsi ; 
Lime-water,  fgii  ; 
Syrup  of  ether, 

Syrup  of  belladonnas,  of  each,  fgiiss  ; 
Syrup  of  orange-flowers,  f^iiss. 
If  this    is    vomited,     then   give    morphine 
hypodermically. — E.  Perier   {Revue  Obstet.  et 
Gynecol.^  August,  1894). 


gms.  zYt, 


gms.  30. 
used  in 


M. 
small 


P-  52 
p.  27 

P-  15 
p.  6 

M. 
Circular  of  a 


THERAPEUTIC  BRIEFS. 

— For  Psoriasis  : — 
I^.     Ichthyol, 

Acid,  salicylic, 

Acid,  pyrogallic, 

Aristol,  aa 

Vaselin, 

Adipis, 

Lanolin,  aa 

A   powerful   ointment,    to  be 
quantities. 

— For    Chronic    Constipation    {Gazetta 
Medica  di  Roma)  : — 
I^,     Aloes,  gi'-  iv 

Strychnia^  sulphat.,  gr.  }( 

Extract,  belladonnae,  gr.  j^ 

Ipecac,    pulv.,  gr.  vss.     M. 

Divid.  in  pil.  xij. 
SiG. — One  every  evening. 
— In  the  German  army  the  following    appli- 
cation    is     employed    for  the  rapid    cure   of 
Blisters   of  the  feet   incident  to  long  marches 
(^Therapeutic  Gazette)  : — 
]^.    Saponis  nigri, 
Aquae, 
Vaselin., 
Zinci  oxidi, 

Essentige  lavandulse,  q.  s. 
— From   Medical  Press   and 
recent   date  we  quote   the  following  prescrip- 
tions : — 

Application   for  Chronic   Pharyngitis  : — 
^.    lodi,  gr-  vj 

Potassii  iodidi,  gr.  xij 

Mentholis,  oj« 

Glycerini,     q.  s.  ad  zy    M." 

Apply   with   a   camel's-hair   brush    twice  or 
thrice  daily.  . 

Useful  in  Bronchitic  Asthma  : — 
I^.    Potassii  iodidi,  3ij 

Amnion,  carb.,  3j 

Tinct,  lobelias,  f^ij 

Sp.  chloroformi,  f^iv 

Vin  ipecac,  f3J_ 

Infus.  senegje,  q.s.  ad  fgvj         M. 

A    tablespoonful    in  a   wineglassful  of  water 
every  four  hours. 

Incontinence  of  Urine  : — 
I^.    Tincturas  belladonnse, 

Tincture  cubebfe,         aa       f^ij 
Tincturee  nucis  vomicae, 
Tincturas  rhei  aromaticae, 

of  each,  foj 

Tincturse  cascarillae,  foij 

12  drops  at  bed-time  for  a  child  from  seven 
to  ten  years. 

The  Removal  of  Warts  : — 

Rj,     Hydiarg.  bichlor.,  gr.  v 

Acid,  salicyl.,  5j 

Collodii,  fsj  M- 


26o 


THE  CANADA  MEDICAL  RECORD. 


This  is  applied  every  day,  the  upper  crust  of 
the  previous  application  being  removed  before 
a  fresh  one  is  made.  Usually  after  four  appli- 
cations the  wart  becomes  so  softened  that 
gentle  friction  will  remove  it  painlessly.  If  a 
further  dressing  is  required,  a  five-per-cent. 
salicylic-lanolin  ointment  is  all  that  is  neces- 
sary. 

Oz.EXA. — Dr.  Stein  obtains  in  oz?ena  most  re- 
markable results  from  i)ainting  the  nasal  fossai 
with  a  solution  of  trichloracetic  acid.  The 
painting  is  done  by  means  of  a  piece  of  cotton- 
wool steeped  in  a  solution  (one-tenth  per  cent.) 
and  fixed  on  the  point  of  a  flexible  wire.  The 
operation  is  done,  tiiree  times  daily  for  the 
first  few  days  J  and  then  once  a  day.  The 
strength  of  the  solution  is  gradually  increased. 
Asthma. — The  following  will  be  found  most 
useful  in  this  distressing  complaint  : — 
I^.     Chloralis, 

Potassii  iodidi,  of  each,  gss 

Syrup  of  oranges,  f.^vj 

Water,  fgvj 

2  to  5  tablespoonfuls  a  day. 

— For  Diphtheria  ( Woman'' s  Medical  Jour- 
nal, April,  1894) : — 

I^'.    Caffeinje,  gr.  xx 

Sodii  bicarb.,  gr.  v 

Aqute,  q.'s.  ad  f3  ij         M. 

Big. — Apply  locally  as  a  spray  to  the  mem- 
brane. 

— Woodbridge  {Jour.  Am.  Med.  Asso.  in 
7/ie  Philadelphia  Polyclinic)  claims  very 
positively  that  Typhoid  Fever  may  be  aborted, 
and  that  he  hasj.been  able  to  accom.plish  this. 
He  believes  the  disease  is  due  to  a  germ  having 
its  effect  in  the  alimentary  canal ;  and  that 
when  a  germicide  powerful  enough  to  destroy 
it  without  detriment  to  the  patient  can  be 
brought  in  contact  with  it,  the  problem  of  the 
abortive  treatment  of  typhoid  fever  is  solved. 
For  this  purpose  he  uses  the  following  mix- 
ture : — 

I^.    Podophyllin,  gr.j 

Hydrarg.  chlor.  mit.,  .^j 

Guaiacol  carb.,  .oVj 

.  Thymol,  .^v 

Menthol,  n) 

Sacch.  alb.,  31J 

Eucalyptol  (as  much  as  possible). 
This  he  uses  in  very  minute  doses  [one-quar- 
ter grain]  every  half  hour  or  hour. 
Later  he  gives 

!^.    Eucalyptol,  .^ss 

Spir.  rect.,  .^j 

Guaiacol,  ^ij 

Aqure  dist.     q.  s.   ad  ^iv 

SiG. — One-half  teasi)Oonful  every  three  or 
four  hours,  until  the  temperature  has  been  nor- 
mal for  a  day  or  two. 

— When     Seborrhceic     Eczema    becomes 


universal,  Unna  has  the  patient  put  on  at 
night  a  woollen  garment  soaked  in  a  wash-basin 
half  full  of  water  containing,  for  adults,  five 
grams  of  resorcin,  and  for  ciiildren  two  grams, 
andwrap  himself  up  between  blankets.  During 
the  day  the  following  ointment  is  applied  : — 
II .    Zinci  oxidi,  parts  vi 

Sulphuris  prjecipitati,         "     iv 
Terrse  silicece,  "     ij 

Adipis  benzoati,  "     xxviij.  M. 

SiG. — Paste. 

For    Insomnia    (Bartholow,    in     JFoman's 
Medical  J  onrnal)  : — 

R.    Antimonii  et  potass,  tar- 
trate, gr.  i-ij 
Morphiae  sulphat.,  gr.  iss. 
Aq.  laurocerasi,                      f5J.  M. 
SiG. — Teaspoonful  every  two,    three,  or  four 
hours  as   required  (in    wakefulness   of  fevers)! 
— In  operating  for  Appendicitis,  Prof.  Keen, 
as  a  rule,  removes  the   ap])endix.     He  thinks 
that  it  is   bad    surgery  lo    leave   the   appendix 
unless  the  adhesions  are  very  marked  and  can- 
not   be  separated   without  the   risk   of  harm. 
Where   there   is   liability  of  breaking  into  the 
general  peritoneal  cavity  he  does  not  search  for 
the  appendix.     \Vhere    there  is    a  tumor    he 
makes  the  incision  over  the  tumor.     He  thinks 
that  we  should  not  go  through  the  peritoneal 
cavity.     It  is  rare  to  have  an  appendicitis  going 
onto  a  condition  of  distinct  tunior  without  pus 
being  present.     He    would  much    rather  oper- 
ate before  any   appreciable  tumor  has  formed. 
In  cases  of  tumor  he  almost  invariably  operates 
even  with  a   normal    temperature  or  a  declin- 
ing temperature. 
— Sedative    Plaster  {A?ncr.  I?ruxi;isl)  : — 
Lead  plaster.                      1  o  parts 
Extract  of  belladonna. 
Resin  of  Pinus  sylvestris, 

of  each  i  part 
Mix  and  spread  on  linen  in  the  manner  of  an 
adhesive   plaster,   and   apply   over  the   painful 
sites  in  rheumatism,  pleurodynia,  etc. 

— For  the  local  treatment  of  Psoriasis 
(Eddowes,  Atncr.  Z>ruj^i;/st)  : — The  various 
patches  are  painted,  after  removal  of  the  scales 
with  soap  and  hot  water,  with  a  saturated  sol- 
ution of  tincture  of  iodine,  about  once  a  week, 
and  an  ointment  consisting  of  equal  parts  of 
unguentum  sulphuris  and  unguentum  picis 
liquidum  applied  daily.  Another  useful  appli- 
cation is  the  following  : — 

U.     Unguent,  picis  liquida;,  ."iiss 

Acid  salicylic,  gr.  xxv 

Unguent,  lanolin,         ad.  3J         M. 

— For  Conjunctivitis  (^Therapeutic  Ga- 
zette):— 

U.     Acidi  borici,  gr.  xx 

Sodii  chloridi,  gr.  viij 

Aqua;  destillat.,  f.^ij  M. 

SiG, — Use  freely  as  a  lotion  every  four  hours, 
first  warming. 


THE  CANADA  MEDICAL  RECORD. 


261 


TUMOR  OF  THE  FACE. 
By  Charles  McBurmey 

Professor  of  Surgery,  College  of  Physicians  and 

Surgeons  ;  Attending  Surgeon  Roostvelt 

Hospital,  N.  V. 

This  man  is  54  years  old.  About  four  years 
ago  lie  began  to  have  pain  in  the  regions  of  the 
infra-orbital  nerve  on  the  right  side,  which  was 
very  persistent,  and  gradually  extended  over 
that  entire  side  of  the  face.  He  has  had  no 
epistaxis  ;  there  is  no  occlusion  of  the  nostrils  on 
either  side  ;  most  of  his  teeth  in  the  u[)per  jaw 
are  gone,  and  the  sockets  are  in  good  condition. 
The  roof  of  the  mouth  is  symmetrical,  and  there 
is  no  abnormality  on  either  side.  When  we 
come  to  examine  outside  and  above  the  alve- 
olar process  on  the  right  si  le,  we  find  a  swell- 
ing, which  apparently  arises  from  the  superior 
maxilla,  which  is  firm  to  the  touch  and  is  cov- 
ered with  perfectly  healthy  mucous  membrane. 
This  tumor  produces  a  slight  bulging  of  the  face 
on  the  right  side. 

We  are  in  ignorance  both  as  regards  the 
nature  of  this  growth  and  its  exact  seat  of  origin. 
After  the  age  of  forty-five  or  fifty  a  large  pro- 
portion of  tumors  of  the  upper  jaw  belong 
either  to  the  carcinomatous  or  sarcomatous 
variety  ;  even  in  earlier  life,  about  one-third 
are  sarcomatous,  one-third  carcinomatous,  and 
the  remainder  belong  to  the  other  varieties.  In 
this  case,  I  think,  we  mny  exclude  empyema  of 
the  antrum,  ordinary  hydrops,  and  probably  any- 
thing in  the  nature  of  a  cyst.  When  we  take 
into  consideration  the  fact  that  this  disease  has 
existed  for  four  years,  and  that  there  is  as  yet  no 
involvement  of  the  mucous  membrane,  it  is  clear 
that  it  has  progressed  slowly,  and  this  permits  us, 
I  think,  to  exclude  carcinoma,  positively,  and 
perhaps  sarcoma.  Some  oftiie  latter  variety  of 
growths  are  very  slow  in  reacliing  their  full  devel- 
opaients,  even  in  this  region,  but  usually  they 
distinctly  manifest  their  presence  by  a  decided 
destruction  of  tissue  long  before  thiee  or  four 
years  have  elapsed.  In  one  case  coming  under 
my  observation  I  removed  from  the  inner  side 
of  a  man's  thigh  a  tumor  as  large  as  a  two  year 
old  child's  head,  which  had  apparently  remained 
unchanged  for  several  years,  and  had  existed 
in  all  over  twenty  years.  At  the  time  of  opera- 
tion I  supposed  we  had  to  deal  with  a  hpoma, 
containing  considerable  fibrous  tissue,  but  on 
examining  it  we  found  a  sarcoma,  well  encap- 
sulated. 

In  trying  to  arrive  at  a  diagnosis  in  the  case, 
it  is  well  to  think  of  other  growths  besides 
those  mentioned.  It  may  prove  t(j  be  a  pure 
osteoma,  which  is  dense,  firm  and  smooth  to 
the  touch,  and  steadily  increases  in  size.  Or 
it  may  bean  enchondroma,   which  is  almost  as 


firm  as  an  osteoma  ;  or  we  may  have  to  deal 
with  a  pure  fibroma,  which,  properly  speaking, 
belongs  to  the  sarcomatous  variety. 

The  diagnosis  in  such  a  case  as  this  is  of  the 
utmost  importance,  as  upon  it  depends  the 
severity  of  the  operation  which  it  will  be  neces- 
sary to  perform.  If  the  growth  proves  to  be  a 
sarcoma,  originating  in  the  antrum  or  the  supe- 
rior maxilla,  it  would  be  wise  to  perform  a  rad- 
ical operation,  even  to  the  extent  of  removing 
the  entire  upper  j  iw,  but  it  would  be  humiliat- 
ing to  do  this  and  learn  afterwards  that  the 
tumor  was  simply  an  osteoma  or  an  enchon- 
droma. 

To  clear  up  the  diagnosis  I  will  make  an 
incision  downwards  from  the  right  ala  nasi  to 
the  mouth.  By  dissecting  up  this  flap  and  turn- 
ing it  back,  a  view  of  the  tumor  is  obtained. 
It  rests  in  the  canine  fossa  and  originates  in 
the  tissues  ou;side  of  the  bone.  The  growth  is 
about  the  size  of  a  pigeon's  egg,  and  is  easily 
dissected  loose.  The  tissues  which  compose 
it  are  hard  and  fibrous  ;  a  microscopical  exam- 
intion  will  be  required  in  order  to  determine 
its  exactcharacter. — Intern,  four,  of  Surgery. 


CLASS-ROOM   NOTES. 

—  Tu/nors  of  the  Subcutaneous  Tissue  or 
of  the  intermuscular  fascia,  Prof  Keen  says, 
should  be  removed  as  often  as  they  recur,  and 
if  a  limb  is  deeply  involved  it  should  be  ampu- 
tated. 

— Prof  Wilson  says  that  when  Relapsing 
Pever  attacks  the  well-nourished,  it  ruiis  a 
similar  course  and  presents  the  same  charac- 
teristics that  it  does  when  it  attacks  the  desti- 
tute. 

— Prof.  Longstreth  says  in  a  similar  number 
of  males  and  females  attacked  with  gonorrhoea' 
the  males  will  be  found  to  suffer  more  frequently 
from  Gonorrheal  Rheumatism  than  the  fe- 
males. 

Whilst  a  Keloid  is  growing.  Prof  Keen  saysi 
its  removal  by  the  knife  should  not  beattempf 
ed  ;  repeated  scarification  or  multiple  electro- 
lytic punctures  sometimes  succeed  in  destroy- 
ing it. 

— Prof.  Wilson  says  whilst  those  in  a  condition 
of  poverty  and  uncleanliness  and  privation  are 
most  often  attacked  with  influenza,  the  rich 
who  are  surrounded  with  all  cleanliness  are 
often  attacked. 

— Plessure  on  a  Fungus  Cerebri  by  sponges 
or  dressings  sometimes,  according  to  Prof. 
Keen,  yields  good  results,  but  at  other  times 
convulsions  follow  the  application  of  pressure, 
when  it  must  be  abandoned. 


262 


THE   CANADA   MEDICAL   RECORD. 


THE  CANADA  MEDICAL  RECORD 
Published  Moxthly. 


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EDITORS ; 
A.  LAPTHORN  SMITH,  BA..  M.D.,  M.R.C.S.,  Eng..  F.O-S. 

London. 
F.  WAYLAND  CAMPBELL,  M.A. ,  M.D.,  L.R.C.P     Londou 
ASSISTANT  EDITOR 
ROLLO  CAMPBELL,  CM.,  M.D. 

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Smith.  248  Bishop  Street. 

Writers  of  original  communications  desiring  reprints  can 
have  them  at  a  trifling  cost,  by  notifying  JOHN  LOVPXL  & 
SON,  immediately  on  the  acceptance  of  their  article  by  the 
Editor. 


MONTEEAL,  AUGUST,  1895. 


SHOULD       PATIENTS     IN     PRIVATE 

ROOMS  IN  PUBLIC  HOSPITALS  BE 

ALLOWED  TO  HAVE  THEIR 

OWN  DOCTOR.? 

For  most  people  this  question  would  seem 
to  be  an  absurd  one,  for  any  other  answer  than 
the  affirmative  one  would  imply  the  subversion 
of  every  principle  of  right  and  justice.  The 
question  has  been  asked  quite  often  of  late,  and 
has  been  answered  pretty  generally  by  the 
medical  journals  in  Canada  and  the  United 
States  in  a  manner  which  has  not  pleased  the 
cliques,  who,  havin  gsecured  control  of  some  of 
the  public  hospitals  and  a  monopoly  of  attending 
the  poor,  wish  to  use  their  position  as  a  means 
of  taking  from  their  fellow-practitioners  those  of 
the  latter's  patients  who,  by  force  of  circum- 
stances, find  themselves  in  a  private  ward  in  the 
public  hospital.  Many  of  the  laity  are  not 
aware  of  this  unjust  and  selfish  regulation,  and 
others  are  loath  to  believe  that  such  a  thing  is 
possible.  A  wealthy  gentleman,  subject  to 
attacks  of  vertigo,  falls  down  in  the  street.  If 
he  were  left  alone  for  a  few  minutes  he  would 
recover  consciousness,  call  a  cab  and  drive 
home,  where  his  family  physician  would  be 
summoned  to  attend  him.  But  in  less  than 
five  minutes  an  ambulance  arrives,  which 
rapidly  conveys  him  to  the  Royal  Victoria  or 
General  Hospital,  instead  of  taking  him  home. 
When  he  recovers  consciousness  he  finds  him- 
sclfi  n  a  private  ward  in  one  of  these  hospitals. 
He  asks  for  his  family  doctor,  but  he  is  politely 


informed  that  only  the  best  doctors  in  the  city 
are  elected  to  that  hospital,  and  only  those  who 
are  elected  to  the  staff  are  allowed  to  attend  pri- 
vate patients  there,  and  that  his  family  physi- 
cian is  not  one  of  them.  It  is  easy  to  see  how 
prejudicial  to  the  interests  of  the  family  physi- 
cian this  is,  to  say  nothing  of  the  slight  to  his 
reputation  ;  and  it  is  extremely  doubtful  whether 
he  will  ever  have  an  opportunity  of  attending 
either  his  patient  or  any  of  his  family  again. 
Many  of  the  practitioners  of  the  city  are 
murmuring  quite  audibly  against  this  unjust  re- 
gulation, and  it  is  more  than  likely  that  public 
opinion  may  become  so  strong  that  the  manage- 
ment of  the  Royal  Victoria  and  General  will  be 
compelled  to  follow  the  example  of  the  Toronto 
General  Hospital,  the  Hotel-Dieu,  the  Notre 
Dame  and  the  Western,  which  all  place  their 
private  rooms  at  the  service  of  any  reputable 
practitioner  when  patients  are  wiUing  to  pay 
for  them. 

SANITARY      CONDITION       OF      MON- 
TREAL. 

The  physicians  and  druggists  of  Mon- 
treal are  all  agreed  that  there  iTever  has  been 
so  little  sickness  within  the  memory  of  the 
oldest  practitioners,  and  the  superintendent  of 
Mount  Royal  Cemetery  bears  out  that  opinion, 
having  recently  informed  us  that  there  never 
have  been  so  few  deaths  as  there  have  been 
this  summer.  This  is  as  it  should  be,  and  is 
very  gratifying  to  the  medical  profession,  wliich 
has  never  ceased  from  putting  forth  every 
effort  to  improve  the  sanitary  condition  of  the 
city.  Although  the  healthier  condition  of  the 
city  and  the  diminished  death  rate  are  directly 
traceable  to  the  efforts  of  the  physicians,  and 
although  we  were  aware  that  if  our  efforts  were 
successful  there  would  be  much  less  work  for 
us,  and  that  our  incomes  would  consequently 
suffer,  still,  strange  to  say,  many  of  these  sani- 
tary improvements  have  been  persistently 
opposed  by  the  citizens  who  have  been  the 
first  to  benefit  by  them.  They  could  hardly 
understand  such  a  thing  as  a  whole  profession 
working  against  its  own  interest  for  the  public 
good.  We  are  proud  to  say  that  such  has 
been  the  case,  and  feel  that  such  disinterested 
efforts  in  the  public  interest  fairly  entitle  our 
profession  to  the  claim  of  being  one  of  the 
most  noble  of  them  all. 


THE  CANADA  MEDICAL  RECORD. 


263 


THE    BUFFALO    MEDICAL   JOURNAL. 

We  cannot  lay  down  the  August  number  of 
ihe  above  journal,  which  is  its  jubilee  number, 
and  which  we  have  just  perused,  without 
expressing  our  admiration  for  the  enterprise  of 
its  editors,  Drs.  Lothrop  and  Warren  Potter. 
It  was  founded  in  1845  by  Dr.  Austin  Flint,  and 
has  consequently  completed  its  fiftieth  year. 
The  jubilee  number,  besides  containing  many 
very  able  scientific  articles,  is  profusely  illus- 
trated with  engravings  of  the  Buffalo  hospitals. 
We  wish  our  bright  and  newsy  contemporary 
as  much  success  in  the  future  as  it  has  attained 
in  the  past.  It  has  always  been  among  the  most 
welcome  of  our  exchanges. 


A  QUIET  RESTING  PLACE. 

There  are  few  quieter  or  more  charming 
summer  resorts  for  overworked  professional 
or  business  men,  or  more  suitable  for  con- 
valescents, than  the  village  of  Roberval  on  the 
eastern  shore  of  Lake  St.  John,  the  northern 
terminus  of  the  main  line  of  the  Quebec  & 
Lake  St.  John  Railway.  An  air  of  perfect 
restfulness  pervades  the  whole  place,  and  what 
is  perhaps  of  quite  as  great  importance  as  the 
salubrity  of  the  atmosphere  and  the  modify- 
ing influences  of  the  great  inland  sea,  on  the 
shore  of  which  the  village  is  built,  are  the  com- 
forts and  even  luxuries  procurable  at  the 
splendidly  equipped  and  new  hotel  for  tourists 
known  as  the  Hotel  Roberval.  Built  upon  an 
eminence  immediately  overlooking  the  lake,  the 
house  contains  accommodation  for  some  400 
guests.  It  is  heated  by  hot  water  and  furnish- 
ed throughout  with  electric  bells  and  light. 
The  rooms  and  beds  are  quite  luxurious,  and 
the  cuisine  and  service  of  the  best.  There 
are  araple  lawns  and  promenade  grounds,  with 
tennis,  croquet,  billiards,  bowling  alley  and 
other  games,  while  the  country  around 
abounds  in  charming  drives,  and  there  are 
excellent  facilities  for  canoeing,  boating  and 
fishing.  A  fleet  of  four  admirably  equipped 
steamers  is  at  the  disposal  of  tourists,  one  of 
which,  the  large  and  fast  iron  steamboat,  the 
'' Mistassini,"  has  accommodation  for  300  pas- 
sengers, and  makes  daily  trips  to  and  from  the 
Grande  Decharge,  the  scene  of  the  exciting 
sport  afforded  by    the  fishing  for   ouananiche. 


Others  convey  passengers  and  their  canoes 
and  guides,  who  are  bent  upon  camping  tours 
in  the  far  northern  country,  to  and  from  the 
mouths  of  the  large  rivers  that  are  tributary  to 
Lake  St.  John.  So  many  and  so  varied  are 
the  attractions  of  the  locality  that  it  would  be 
difficult  to  find  a  more  suitable  place  than 
Roberval  for  sending  either  convalescent 
patients  in  search  of  strength  and  vigor,  or 
worn  out  business  and  professional  men  in 
search  of  change  and  rest.  We  can  speak 
from  personal  experience,  having  spent  a  most 
enjoyable  holiday  at  the  Hotel  Roberval  and 
in  making  various  fishing  excursions  in  the 
neighborhood. 


PERSONAL. 


Dr.  Elizabeth  Mitchell  has  gone  for  a 
couple  of  months  to  the  seaside,  to  recuperate 
from  her  hard  work  of  the  past  winter.  Those 
who  believe  in  the  right  of  woman  to  attend 
her  own  sex  can  point  with  pardonable  pride 
to  Dr.  Mitchell's  success ;  she  enjoys  a  lucra- 
tive practice  among  many  of  the  leading 
families  of  Montreal. 

Dr.  Grace  Ritchie,  who  is  one  of  the  most 
popular  physicians,  and  has  one  of  the  most 
largely  attended  out-door  clinics  at  the 
Western  Hospital,  has  also  gone  to  the  seaside 
for  a  month.  During  her  absence,  Dr.  Laadau, 
one  of  the  prize  winners  at  Bishop's  College 
last  year,  remains  in  charge  of  her  patients. 

Dr.  Lapthorn  Smith,  who  has  charge  of  the 
Gynaecological  wards  of  the  Western  during  the 
six  summer  months,  has  been  kept  so  busy 
with  operative  work  that  he  has  not  been  able 
to  leave  town.  Although  the  gynaecological 
operating  days  are  nominally  Wednesdays  and 
Saturdays,  so  many  cases  have  been  sent  in  that 
it  has  been  found  necessary  to  operate  nearly 
every  week  day.  Many  of  the  cases  have  been 
very  bad  ones,  requiring  five  or  six  distinct 
operations,  which  he  is  in  the  habit  of  perform- 
ing at  one  seance  of  a  little  over  an  hour,  thus 
saving  the  patient  the  discomfort  of  several 
subsequent  anaesthesias.  His  term  of  service 
for  this  year  ends  on  the  ist  of  October. 

We  regret  to  learn  that  Dr.  J.  Anderson 
Springle  has  severed  his  connection  with 
Bishop's  College,  where  as  professor  of  Anatomy 
he  has  made  a  brilliant  lecord.  We  are  not 
avvare  of  his  reasons  for  taking  this  step,  and 
trust  that  he  may  yet  return,  as  Bishop's  College 
can  ill  afford  to  lose  him.  He  intends,  how- 
ever, to  remain  on  the  staff  of  the  Western 
Hospital,  where  he  is  one  of  the  most  able 
surgeons  in  the  department  of  general  surgery. 


264 


THE   CANADA   MEDICAL   RECORD. 


We  are  glad  to  learn  that  Dr.  F.  R.  England 
is  winning  golden  opinions  both  from  tlie 
students  of  Bishop's  College,  where  he  is  pro- 
fessor of  Surgery,  and  at  the  VVtstern  Hospital, 
where  he  has  been  in  charge  of  the  department 
of  general  surgery  during  the  summer. 

The  Western  Hospital  is  rapidly  coming  to 
the  front  as  one  of  the  leading  hospitals  of 
Canada.  It  has  now  two  well  equipped  operat- 
ing rooms  and  fifty  beds,  which  are  kept  con- 
stantly filled,  not  only  by  patients  from  the  city, 
who  prefer  it  to  any  other  hospital,  but  also  by 
those  who  are  sent  to  it  by  the  physicians  of 
the  Eastern  Townships,  and  even  from  the 
New  England  States,  Although  it  has  a  parti- 
cularly brilliant  record  as  a  surgical  and 
gynaecological  hospital,  it  also  has  a  medical 
staff  consisting  of  such  well-known  names  as 
Dr.  F.  W.  Campbel',  Dean  of  Bishop's  College  ; 
Dr.  McConnell,  Professor  of  Medicine  ;  and 
Dr.  Reddy.  The  next  report  will  show  one  of 
the  lowest  death  rates  in  Canada,  the  few  which 
have  occurred 'beiig  mostly  of  patients  who 
were  admitted  in  a  dying  condition,  and  died 
within  3  days  after  admission. 

The  Western  offeis  special  facilities  for  post 
graduate  students  during  the  summer  months 
when  the  regular  students  are  nearly  all  away. 

We  have  recently  heard  a  suggestion  thit  the 
present  site  of  the  \\'estern  Hospital,  which  has 
become  one  of  the  most  valuable  ones  in  the 
city,  should  be  sold  for  two  hundred  thousand 
dollars,  and  that  with  a  portion  of  the  funds 
thus  obtained  an  equally  suitable  but-  less 
expensive  site  be  purchased,  while  the  re- 
mainder could  be  invested  as  a  permanent  en- 
dowment fund.  As  far  as  we  can  see,  the 
suggestion  is  a  good  one,  and  eventually  we 
hope  to  see  it  carried  out. 

Dr.  Reddy  has  gone  to  New  Brunswick  for  a 
month's  holidays,  which  he  was  much  in  need 
of,  being  director  of  the  Maternity  on  Osborne 
street.  Professor  of  Obstetrics  in  Bishop's 
College,  Physician  to  the  Western  Hospital, 
and  Surgeon  to  the  Samaritan  Hospital. 

Dr.  Grant  Stewart,  who  has  one  of  the  largest 
if.not  the  largest  general  practice  in  Montreal, 
wisely  takes  a  whole  month  every  year,  which 
he  spends  with  his  family  at  Metis  on  the 
Lower  St.  Lawrence,  where  he  is  one  of  the 
most  popular  acquisitions  to  society  there. 


NEWS  ITEMS. 

HALL  OF    THE  COLLEGE    OF  PHYSL 
CIANS. 

Philadelphia,  August  i,   1895. 

'J  he  William  F.  Jenks  meinf)rial   prize  of  five 
hundred   dollars,  under   the    deed  of  trust    of 


Mrs.  William  F.  Jenks,  has  been  awarded  to  A. 
Brothers,     M.D.,    162    Madison   Street,    New 
York,  for  the  best  essay  on  "  Lifant  Mortality 
During  Labor,  and  Ls  Prevention." 

The  Prize  Committee  also  reports  as  highly 
meritorious  the  essay  on  the  same  subject  bear- 
ing the  motto    "  Vade  Mecum." 

The  writers  of  the  unsuccessful  essays  can 
have  them  returned  to  any  address  they  may 
name,  by  sending  it  and  the  motto  which  distin- 
guisl.ed  the  essay  to  the  Chairman  of  the 
Prize  Committee,  Horace  Y.  Evans,  .\LD., 
Colkge  of  Physicans,  Philadelphia. 

James  V.  Ingham, 
Chaules  S.  Wurts, 
I.  Minis  Hays, 
Trustees  of  the   Win.  F.  Jtiiks  Memorial  Fund. 


PAMPHLETS. 

Cystic  Tumors  of  the  Vaginal  Vault, 
WITH  reports  of  TWO  CASES.  By  Fre- 
derick Holme  Wiggin,  M.D.,  Visiting 
Surgeon  to  the  New  York  City  Hospital 
(B.  I.),  Gynaecological  Division,  etc.  Re- 
printed from-  the  New  York  Medical 
Journal  for  July  13,  1895. 

Medical  Terminology  ;  its  Etvmol  h;y  and 
Errors.  By  P.  J.  McCourt,  M.D.,  New 
York.  Reprinted  from  the  .Medical  Record, 
July  27,  1895.  New  York  :  Trow  Direc- 
tory Piinting&  Bookbinding  Co.,  201-213 
East  Twelfth  Street,  1895. 


CLASS-ROOM   NOTES. 

— Yox  Hemorrhoids,  Prof.  Hare  recommends 
the  following  ointment : — 

1^.         Acid,  gallic,  gr.  x 

Extract,  opii,  gr.  iv 

Extract,  belladonnas,  gr.  v 

Unguent,  simplicis,  .^iv.     M. 

SiG.  —Apply  locally  night  and  morning. 

— Ktloid,  according  to  Prof  Keen,  may 
arise  .spontaneously,  but  generally  from  some 
injury  to  the  skin,  cuts,  scars  from  burns,  or 
also  sometimes  from  the  injury  intlicted  to  the 
lobe  of  the  ear  in  perforating  it  for  car-rings. 

— According  to  Prof  Wilson,  the  emacia- 
tion after  an  attack  of  1- nteric  Fever  continues 
until  the  diurnal  temperature  range  becomes 
coincident  with  the  normal,  sometimes  a  patient 
losing  one-sixth  or  one-seventh  of  his  whole 
bodily  weight. 

—  Cubebs,  Prof  Hare  says,  is  useful  in 
.Gonorrtieea,  not  because  it  possesses  any  spe- 
cific action  against  this  disease,  but  because  it 
has  a  beneficial  effect  in  modifying  the  ardor 
urinie,  which  is  generally  the  most  distressing 
symptom  in  gonorrhoea. 


Vol.  XXIII. 


MONTRE.\L,  SEPTEMBER,  1895. 


No.  12. 


SOCIETY  PKOCEEDINGS. 

JMoiitreal  Medico-Cbirurgical    Soci- 
ety   265 

Experimental  Cacliexia  Strumipriva  265 

Gastro-jejunostomy 265 

Pulmonary  Embolism 266 

Aneurism  of  the  Thoracie  Aorta 206 

Two  Cases  of  Pernicious  Ana?mia.  .  267 
Resuscitation  of  a  new-born  child  by 

Rhythniic  Traction  on  the  Tongue.  271 
Aneurism  of   the    Femoral  Artery 
treated  by  Ligature  of  the  Exter- 
nal Iliac  Artery 271 

Experiments  on  Cerebral  Localiza- 
tion  272 

Sarcoma  of  the  Ileum  ;    Resection 

with  the  Murphy  Button  :  Death..  272 
Suppurative    Arthritis    due  to  Ty- 
phoid Bacillus 273 

Rhythmic  Traction  of  the  Tongue. .  274 
Some  interestnig  Conditions  attend- 
ing Post-Nasal  Growths 275 

ISIultiple  Osteo-Myelitis 275 

Compound    Depressed  Fracture  of 
the  Vault  of  the  Skull 275 


OOnSTTEISTTS. 

Seborrhoja '.^76 

A  New  Form  of  Pother  Inhaler 277 

American  Dermatological  Associa- 
tion   280 


PROGRESS  OF  SCIENCE. 

The  Treatment  of  Cystitis 280 

Acute  Infantile  Arthritis  in  the  Hip.  281 
Eye  Strain   a  Cause  of    Nocturnal 

Enuresis 282 

Bacteriological     Examinations     of 
Diphtheria  in  the  United  States..  282 

Treatment  of  Diphtheria 283 

Diphtheria  in  Italy 283 

An  Anomalous  Case  of  Diphtheria  .  284 
The     Immunization     of     Chickens 
against  the  I>iphtheritic  Bacillus, 
and  the    passage  of   Immunizing 
Substai.ces  within  (heir  Eggs..   .   .  284 
Treatment  of   Diphtheria  as  Indi- 
cated by  its  Etiology  and  Pathology  284 
Class-Room  Notes  284 


EDITORIAL. 

Change  of  Management  285 

The  Canadian  Medical  Association..  285 
Municipal  Control  of  Unnecessary 
Noises 280 

BOOK  NOTICES. 

Practical  Dietetics  286 

Green's  Pattology  and  Morbid  Ana- 
tomy    287 

Personals  286 

Pamphlets  Received 287 

Publishers  Department 288 


^acietg     firoccebings. 


MONTREAL      MEDICO-CHIRURGICAL 
SOCIETY. 

Stated  Meeting,  March  ?>th,  1895. 

Dr.    G.  p.  Girdwood,    President,    in    the 
Chair. 

Dr.  R.  A.  Westley,  of  Alexandria,  was 
elected  an  ordinary  member. 

Experimental  Cachexia  Strumipriva. — Dr. 
Wesley  Mills  exhibited  a  dog  from  which 
he  had  removed  the  thyroid  gland.  The  ani- 
mal was  in  good  condition  at  the  time,  and 
bore  the  operation  so  well  that  he  feared  the 
usual  symptoms  were  not  going  to  develop. 
The  operation  was  performed  on  Monday 
evening,  and  on  Friday  most  pronounced 
symptom  of  dyspnoea  and  fibrillary  twitchings 
appeared,  which,  however,  lasted  but  a  short 
time  and  had  almost  disappeared  when  the 
animal  was  shown.  The  only  sympiom  then 
present  was  the  dog's  extreme  dullness.  The 
temperature  was  about  98*,  which  was  for  the 
dog  slightly  subnormal.  The  subject  had 
been  thoroughly  investigated  by  Continental 
and  English  scientists,  notably  Horsley.  The 
symptoms  differed  in  different  animals  ;  but 
were     most    pronounced    jn    the    carnivora. 


Those  referable  to  the  nervous  system  were 
increased  and  then  diminished  function  such 
as  spasms,  and  later  cretinism  and  myxoedema. 
The  dullness  (cretinism)  was  manifest  in  this 
dog  ;  although  the  contrast  between  his  pre- 
sent and  his  usual  behavior  was  not  marked. 
Myxcedema  in  some  cases  needed  careful 
investigation  to  (ind  ;  it  was  certainly  not  pro- 
nounced in  either  of  these  cases.  In  another 
dog  operated  upon,  dullness,  emaciation  and 
dyspnoea  were  the  prominent  symptoms.  The 
explanation  was,  that  by  excision  of  the  thy- 
roid a  controlling  influence  over  metabolism 
was  removed.  The  dyspnoea  was  caused  by 
the  venous  condition  of  the  blood,  and  by  the 
influence  of  toxines  on  the  respiratory  centre. 
The  oedema,  dullness,  etc.,  were  explained  by" 
alterations  in  nutrition  and  in  the  nervous  sys- 
tem. 

Dr.  F.  J.  Shepherd  suggested  that  some  of 
the  symptoms  might  have  been  due  to  the 
effects  of  the  operation. 

Dr.  James  Bell  was  surprised  that  Dr. 
Mills  should  consider  that  the  changes  des- 
cribed could  have  taken  place  in  so  short  a 
time. 

Dr.  W.  S.  Morrow  corroborated  what  Dr, 
Mills  had  said  of  the  animal's  condition. 

Gastro-jejunostomy. — Dr.  F.  J.  Shepherd 
exhibited  a  woman,  ■x.i.  68,  upon  whom  he  had 
performed  this  operation,  and  who  had  been 
sent  to  his  wards  by  Dr.  G.  Gordon  Campbell 


266 


THE   CANADA   MEDICAL   RECORD. 


as  a  suitable  case  for  pylorectomy.  The 
tumor  about  the  pylorus  seemed  small,  well 
defined  and  unattached.  'J'he  patient  readily 
consented  to  operation,  and  on  August  nth, 
i894;  an  incision  was  made  in  the  median  line 
and  the  tumor  examined.  The  case  seemed 
favorable  for  ])ylorectomy,  so  the  omentum 
was  tied  off,  and  on  lifting  up  the  stomach  a 
large  mass  of  infiltrated  glands  was  seen  on 
the  1  osterior  wall  of  the  abdomen.  All  idea 
of  continuing  the  operation  of  excision  was 
abandoned  and  gastro-enterostomy  performed. 
A  piece  of  jejunum  wns  brought  up  to  the 
anterior  wall  of  the  stouiach  and  fixed  there  by 
a  double  row  of  sutures,  the  outer  row  of  Lem- 
bert  sutures  was  continuous.  No  plate,  button 
or  other  mecltanical  device  was  used.  ''  he 
patient  did  [perfectly  well,  and  went  out  of  hos- 
pital during  the  first  week  of  September,  being 
anle  to  eai  with  comfort,  the  vomiting  having 
altogether  ceased.  Dr.  Shepherd  had  not  seen 
the  patient  again  until  a  few  days  ago,  when 
she  sent  for  him  ;  he  found  she  was  suffering 
from  diarrhoea.  Since  leaving  hospital  she 
had  been  attending  to  her  household  duties  as 
usual,  and  had  no  trouble  about  eating.  'I he 
tumor  could  siill  be  felt  somewhat  larger  than 
in  the  summer,  but  patient  looked  well  nour- 
ished and  had  a  henlthy  appearance  and  did 
not  suffer.  Dr.  Shei^herd  said  that  he  thought 
the  results  of  this  operation  were  excellent,  and 
it  was  worth  doing  to  obtain  six  months  free- 
dom from  pain,  and  this  comfort  with  the 
chance,  judging  from  her  present  condition,  of 
enjoying  several   months  more  of  good  health. 

Dr.  G.  GoRDOM  Campbell  siid  that  there 
had  been  almost  entire  nbsence  of  symptoms 
pointing  to  gastric  cancer  previous  to  her 
admission  to  hospital.  The  tumor  had  been 
discovered  on  making  an  examination  of  the 
abdomen.  There  had  been  no  pain  or  vomit- 
ing, and  general  debility,  for  which  she  had 
spent  a  couple  of  weeks  at  the  seaside  without 
benefit,  wns  the  chief  complaint.  While  in  the 
medical  wards  vomiting  had  commenced,  and 
atone  time  a  \ery  large  quantity  of  stomach 
contents  was  expelled.  'I'he  tumor  was  about 
tjie  size  of  an  egg,  freely  movable  and  situate 
about  one  inch  above  the  umbilicus.  Its  con- 
nection with  the  pyloric  end  of  the  stomach 
was  easily  determined  by  dilating  that  organ. 
A  test  meal  had  been  given  and  absence  of 
hydrochloric  acid  demonstrated. 

Piihnonary  Embolism. —  Dr.  W.  G.  John- 
ston showed  a  specimen  illustrating  obstruc- 
tion of  the  pulmonary  artery  by  an  embolus. 
A  number  of  rounded  masses  of  blood  clots 
obstructed  the  pulmonary  artery  in  each  lung. 
The  history  was  interesting,  both  from  a 
pathological  and  medicolegal  stand|)oint. 
The  man  had  been  dead  and  buried  about  one 
week,  when  one  of  his  friends  made  a  curious 
statement  :     that   the  deceased  had   exi)ected 


some  accident  to  happen  to  him,  and  some 
persons  were  reported  to  have  been  laying 
traps  for  him.  A  post-mortem  was  ordered, 
and  this  curious  condition  of  obstruction  in 
the  pulmonary  artery,found.  No  evidence  of 
any  primary  source  of  an  embolus  could  be 
detected,  and  this  made  it  difficult  to  decide 
between  embolism  and  thrombosis.  In  favor 
of  thrombosis  was  the  atheromatous  condition 
of  the  pulmonary  arti-ry,  the  heart  showing  an 
unusual  condition  of  great  dilatation  on  the 
right  side.  He  was  said  to  have  had  a  systo- 
lic murmur,  transmitted  very  distinctly  to  the 
right,  and  owing  to  his  having  a  very  slow, 
heaving  pulse,  it  was  thought  to  be  an  aortic 
direct  murmui,  and  there  was  some  thickening 
of  the  aortic  valve.  Fr.  Johnson,  however, 
thought  the  murmur  was  produced  in  the 
right  side. 

Aneurism  of  the  Thoracic  Aorta.  —  Dr. 
Adami  exhibited  the  specimen,  and  read  the 
report. 

Dr.  Jas.  Stewart  described  the  treatment  of 
the  case. 

Dr.  Wesley  Mills  emphasized  the  value  of 
laryngoscopic  examination  in  diagnosing  aneu- 
risms of  the  aorta. 

Dr.  Finlev  thought  that  Dr.  Adami's 
explanation  of  the  difference  between  the  pulse 
in  the  two  radials  was  very  ingenious,  and 
seemed  to  be  confirmed  by  the  a'natomical  con- 
ditions present.  He  also  thought  that  the  late 
Dr.  MacDonnell's  explanation  of  the  tracheal 
tugging — the  aneuri'^m  pressing  upon  the  left 
bronchus  and  pushing  it  down  with  each  pulsa- 
tion— was  borne  out  by  this  case. 

Dr.  I^AFLEUR  had  at  present  under  observa- 
tion a  case  of  thoracic  aneurism,  the  diagnosis 
of  which  was  made  by  a  laryngologist,  and  not 
by  himself.  The  patient  had  been  suffering 
from  aortic  insufficiency  for  fifteen  years,  and 
had  been  under  the  speaker's  care  for  a  year. 
He  developed  pain  of  a  fixed  character  in  the 
epigastrium,  generally  so  severe  as  to  prevent 
sleep  at  night.  A  troublesome  cough,  with 
huskiness,  developed,  and  exiinination  of  the 
lungs  gave  negative  results.  There  was  no 
alteration  in  the  size  of  the  pupils,  and  no 
evidence  of  intrathoracic  tumor.  He  finally 
had  Dr.  Birkelt  see  the  man,  and  an  aneurism 
was  detected  projecting  into  the  trachea,  imme 
diately  above  its  bifurcation,  about  the  size  of" 
a  walnut.  This  case  illustrated  the  importance 
of  internal  as  well  as  external  examination  in 
such  cases.  Here,  from  the  point  of  view  of 
external  examination,  there  was  nothing  at  all 
to  suggest  aneurism,  except  trachea  tugging, 
which  was  discovered  to  be  present  after  the 
laryngological  examination  had  been  made. 

Dr.  H.  D.  HAiMii.TON  had  (iften  treated  the 
patient  for  his  laryngeal  complaint  at  the 
Loiigue  I'ointe  Home.  He  happened  to  be  at 
the  Home  one  day  examining  some  cases  with 


THE  CANADA  MEDICAL  RECORD. 


267 


Dr.  Thompson,  when  this  last  ilhiess  began.  A 
sudden  attack  of  dyspnoea  had  set  in,  during 
the  course  of  a  broncliilis  from  which  he  was 
suffering,  which  made  iheni  at  first  suppose  the 
aneurism  had  ruptured.  Pain  was  always  a 
prominent  symptom,  and  it  was  constantly 
referred  to  the  right  side.  Belladonna  plasters 
gave  marked  relief  when  used  in  addition  to 
the  internal  medication.  The  patient  lived 
just  one  week  after  this  attack. 

Tivo  Cases  of  Pernicious  Ancemia. — Dr.  F. 
G.  FiNLEY  read  a.  paper  on  this  subject  as 
follows  : 

Of  the  two  cases  reported  below,  both  were 
regarded  during  life  as  pernicious  anaemia. 
The  second,  however,  was  clearly  shown  by 
the  post-mortem  examination  not  to  be  of  this 
nature.  As  they  both  presented  a  severe  form 
of  anaemia,  poikilocytosis  and  absence  of  free 
acid  in  the  stomach,  they  are  recorded,  inas- 
much as  the  association  of  these  conditions  is 
still  involved  in  considerable  obscurity. 

Case  I. — Pernicious  ancemia,  absence  of 
hydrochloric  acid  in  gastric  juice — Marked 
improvement  after  thymol — Failure  of  arsenic 
and  bone  marrow. 

Case — H.  J.,  male,  cct.  52,  of  temperate  ha- 
bits, was  sent  to  the  Montreal  General  Hospi- 
tal by  Dr.  Hutchison  on  November  17,  1894, 
complaining  of  indigestion,  vomiting  and  weak- 
ness. 

He  states  that  he  has  had  small-pox  and 
gonorrhoea.  He  has  not  been  strong  for  ten 
years,  and  has  suffered  from  vomiting,  lasting  a 
day  or  two  at  a  time,  two  or  three  times  yearly. 
He  has  been  much  worried  of  late  by  family 
trouble. 

Present  illness — Began  in  August,  1894,  with 
weakness  and  loss  of  flesh.  For  several  months 
he  suffered  from  nausea  and  occasionally 
vomiting  induced  by  slight  exertion.  At  no 
time  vvas  there  any  abdominal  pain  or  haema- 
temesis.  Increasing  weakness  obliged  him  to 
take  to  bed  about  the  end  of  October,  and  the 
vomiting  continued  up  to  the  time  of  admission 
to  hospital.  He  has  lost  about  twenty-five 
pounds  in  weight. 

Family  History — Father  is  healthy,  Kt.  82; 
mother,  a  sister  and  brother  died  of  consump- 
tion, and  a  brother  is  stated  to  have  died  of 
anaemia. 

Present  condition — He  is  moderately  nour- 
ished, the  panniculus  adiposus  is  small.  The 
muscles  are  soft  but  of  fair  size,  and  the  weight 
is  124  pounds.  The  skin  is  moist  and  perspir- 
ing. The  face  and  back  of  hands  are  of  a  de- 
cided lemon  color,  and  the  conjunctivae  show 
a  slight  yellow  hue.  The  mucous  membranes 
are  pale,  and  there  is  a  considerable  degree  of 
anaemia  present.  The  tongue  is  moderately 
coated  and  flabby.  The  abdomen  is  normal, 
presenting  no  tenderness  or  tumor,  and  the 
liver  and  spleen  are  not  enlarged.     The  heart 


is  of  normal  size  ;  a  soft  systolic  murmur  is 
heard  with  maximum  intensity  at  the  pulmon- 
ary cartilage,  transmitted  to  the  aortic  and 
down  the  sternum  as  far  as  the  fourth  costal 
cartilage.  The  lungs  are  normal.  The  urine 
is  acid,  S  G.  1020  ;  no  albumen,  sugar,  urobilin 
or  bile  coloring  matters  are  present. 

November  18. — Blood  examination  shows 
slight  irregularity  in  the  shape  of  the  corpus- 
cles (poikilocytosis)  and  a  few  small  corpus- 
cles (micro-cytes)  are  present.  On  Nov,  25th 
red  cells,  1,928,770  to  cm.;  haemoglobin  45 
percent.  (FleischI).  Stained  specimens  show 
some  irregularity  in  shape  and  size  of  the  cor- 
puscles and  a  few  microcytes.  Ratio  uf-red  to 
N'hite  3  to  508.  The  gastric  contents  with- 
drawn after  a  test  meal  show  an  entire  absence 
of  hydrochloric  acid  (Congored,  Boas  and 
Gunzberg's  tests);  lactic  acid  absent. 

The  red  corpuscles  have  become  more  irre- 
gular in  shape.  Careful  measurements  show 
that  many  of  them  are  larger  than  normal, 
measuring  9  to  10  rn.,  instead  of  7  to  8m.;  a 
few  microcytes  3  6  m.  The  white  cells  are  re- 
latively but  not  absolutely  increased.  Nu- 
cleated red  cells  have  not  been  found  in  repeated 
examinations. 

The  urine  has  varied  considerably,  S.G. 
loi 5-1020,  being  on  soine  occasions  dark  in 
color  and  at  others  light.  Urobilin  (Hup- 
pert's  test)  has  been  frequently  but  not  always 
present,  and  the  spectrum  of  pathological  uro- 
bilin has  also  been  occasionally  seen. 

On  January  23,  the  spleen  was  felt  below  the 
costal  border,  and  has  since  continued  en- 
larged. On  March  17  a  severe  attack  of  facial 
erysipelas  set  in,  the  temperatures  ranging  from 
103°  to  105°,  and  termniating  by  crisis  on  the 
sixth  day. 

With  the  exception  of  this  attack  of  erysipe- 
las referred  to,  there  was  no  fever  during  the 
six  months  that  the  patient  was  under  observa- 
tion. Retinal  haemorrhages  were  almost  ab- 
sent. The  weight  fluctuated  from  119  to  124 
lbs.  Vomiting  occurred  a  few  times  in  the  fort- 
night following  admission,  and  then  cea,sed. 
The  stools  were  examined  for  intestinal  para- 
sites with  a  negative  result. 

The  blood  began  to  improve  in  the  first  half 
of  March,  and,  as  will  be  seen  by  referring  to 
the  table  appended,  by  the  end  of  April  almost 
reached  the  normal.  Corresponding  with  the 
improvement  of  the  blood  conditions,  the  pa- 
tient's strength  and  energy  returned,  and  he  was 
able  to  leave  the  hospital  on  May  16. 

The  shape  of  the  blood  corpuscles  has  al- 
ways continued  irregular,  and  hydrochloric  acid 
has  been  persistently  absent  from  the  gastric 
juice. 

Treatment — Arsenic  has  been  faithfully  used 
for  several  months,  also  bone  marrow,  iron  and 
latterly  thymor  have  also  been  given  a  trial. 
Arsenic  has  been  used  throughout  internally  in 


268 


THE   CANADA   MEDICAL   RECORD. 


the  shape  of  Fowler's  solution  in  doses  of  from 
m  ii  to  m  x  t.i.d.  The  stomach  would  not  tole- 
rate a  large  dose,  and  on  several  occasions  it 
had  to  be  discontinued.  Arsenious  acid  in 
pill  form  was  better  borne,  and  hypodermics 
of  Fowler's  solution  in  water  were  also  tried, 
but  proved  painful,  and  were  discontinued  on 
the  formation  of  a  small  abscess.  A  glycerine 
extract  of  bone  marrow  was  used  from  January 
8  to  February  8,  during  which  time  the  corpus- 
cles decreased  from  1,792,000  to  1,320,000,  al- 
though there  was  a  slight  increase  in  the  h?emo- 
globin  35  per  cent,  to  45  per  cent.  Blaud's 
pills  in  doses  of  10  to  15  gis.  t.i.d.  were  used 
from  February  8lh  to  ISlarch  4th,  the  red  cor- 
puscles rising  in  this  period  from  1,320,000  to 
1,770,000,  but  with  a  decrease  of  haemoglobin. 
On  March  3rd  thymol  was  commenced.  A 
reference  to  the  table  below  will  show  the  rela- 
tion of  the  blood  count  to  the  principal  drugs 
used. 

Blood  Counts. 

Nov.  25 Red  B.C.    1,928,000  Hglobin  45% 

Jan.    7 1,792,000  Fleischl  30%  to  25% 

25 1,820,000  40/^ 

Feb.  6 1,320,000  40% 

12 1,340,000  45% 

March  4 1,770,000  3°^  to    35% 

14 2,440,000  45/r 

April  5 2,S6o,ooo  65/ 

12...  3,140,000  65%   to    70% 

30  . . .  4,810,000  80%   to  85% 

June  26 2,197,000  40% 

Treatment. 

Nov.  24th.  Arsenic  in  v  to  x,  and  also  allernating 
with  1-20  gr.  arsenious  acid  t.i.d.  taken  during  almost 
whole  period  of  hospital  residence.  Jan.  8  to  Feb.  8. 
Bone  marrow. 

March  3  to  June  15.     Thymol  gr.  }4  to  gr-  l}it.iA. 

March  17  to  22.     Erysipelas. 

On  comparing  the  blood  counts  with  the 
treatment,  it  will  be  noted  that  no  improvement 
appeared  with  arsenic.  All  the  blood  counts 
made  after  March  4th  showed  a  steady  improve- 
ment, which  was  coincident  with  the  use  of  thy- 
mol and  arsenic,  and  which  had  not  been  effect- 
ed by  the  use  of  arsenic  alone.  The  experience 
of  this  case  is  certainly  suggestive  of  the  bene- 
ficial action  of  thymol.  The  attack  of  erysipe- 
las complicated  the  case  at  this  stage,  and  sug- 
gests the  possibility  of  its  exerting  a  modifying 
influence  over  the  disease.  It  will,  however, 
be  noted  that  the  improvement  began  before 
the  attack  of  erysipelas,  and  co-incidentally 
with  the  use  of  thymol. 

A  blood  count  made  June  25111  showed  a 
great  decrease  in  the  number  of  corpuscles  and 
haemoglobin,  a  relapse  so  fre(]ucntly  seen  in 
pernicious  auitmia. 

Case  II. — Severe  aiuciiiia — Arterial  sclero- 
sis— Dilated  heart — Absence  of  liydt  ochloric 
acid  in  Gastric  fliiiii — Autopsy. 

R.  O'C,  ;\et.  61,  laboier,  admitted  to  the 
Montreal   General  Hospital    on  January  25th, 


1895,  complaining  of  weakness  and  shortness 
of  breath. 

Personal  history — He  has  had  measles, 
whooping  cough  and  scarlet  fever,  but  no  vene- 
real disease. 

Present  illness  began  in  the  spring  of  1S94 
with  frequency  of  micturition,  and  in  Novem- 
ber, there  were  severe  paroxysms  of  pain  in 
the  right  groin. 

In  October,  189.^,  began  to  be  much  troubled 
with  shortness  of  breath,  especially  on  going 
up  steps,  and  about  this  time  he  noticed  his 
face  to  be  of  a  slight  yellow  color.  He  has 
noticed  for  some  time  back  small  red  spots  on 
the  hands,  lasting  from  a  week  to  ten  days,  evi- 
dently subcutaneous  hcemorrhages.  He  has 
had  palpitation,  dizziness,  and  has  lost  about 
30  lbs.  in  weight.  He  has  never  had  headache, 
nose  bleeding  or  diarrhoea.  He  has  vomited 
on  three  occasions,  and  suffered  a  few  times 
from  heartburn. 

Family  history — Father  died  from  fever  and 
ague  ;  mother  died  at  57  from  an  illness  at- 
tended by  cough  and  expectoration. 

Present  conililion  —  He  is  rather  thin,  the 
muscles  are  soft  and  the  panniculus  adiposus  is 
small ;  weight  125  pounds.  The  face  and  back 
of  hands  are  of  a  marked  yellow  hue,  and  there 
is  marked  pallor  of  the  conjunctivas  and  gums. 
Two  small  subcutaneous  haemorrhages  on  the 
back  of  the  right  hand. 

The  arteries  show  a  moderate  degree  of 
thickening;  pulse  84,  slight  irregularity  in 
rhythm  and  tension  not  increased  ;  the  apex  im- 
pulse is  strong  and  in  the  nipple  line,  the  car- 
diac sounds  are  normal.  The  lungs  and  abdo- 
minal viscera  present  no  abnormality  on  physi- 
cal examination.  Urine  pale,  S.G.  1015,  no 
albumen  or  sugar.  Urobilin  negative  with  the 
spectroscope. 

Jan.  26. —  Blood  count,  red  cells  3,320,000; 
h;\jmoglobin  25  to  30  per  cent.  (Fleischl).  Ir- 
regularity in  size  and  shape  of  the  cor|)uscles 
is  well  marked.  Hydrochloric  acid  absent 
from  gastric  contents  in  a  test  meal  by  same 
tests  as  used  in  first  case.  Subsequent  blood 
(  examinations  were  made  as  follows  : 

I    Feb.    12.    Red  ceUs.  2,250,000  ;h:einoglobin,  20  to  2.".  iier  cent 
,'        "       28  "  2,(>Ci»,(X)i)  :  "  20  to  25 

.Mcli.     3  '•  2,;»0,0O0  ;  "  20  to  2,-j        " 

Numerous  examinations  were  made  of  stain- 
ed specimens  of  blood.  These  always  showed 
marked  irregularity  in  size  and  shape  of  the 
red  blood  coipuscles.  Most  of  the  cells  were 
under  rather  than  over  the  size  of  a  red  blood 
corpuscle,  a  very  common  size  being  5.4  m.; 
microcytcs  were  not  numerous,  and  the  largest 
cells  have  not  been  over  10  m.  No  nucleated 
red  cells  have  been  seen. 

'l*he  uiine  has  been  for  the  most  part  pale  in 
color,  occasionally  somewhat  dark.  It  has 
frequently  in  both  pale  and  d;irk  specimens 
shown  the  presence  of  urobilin  with  Hupperl's 


THE   CANADA   MEDICAL   RECORD. 


269 


test,  but  not  with  the  spectroscope.     The  sp. 
gr.  has  usually  been  about  10 15. 

The  temperature  has  been  normal  through- 
out. There  have  been  no  retinal  liKmorrhages, 
but  occasionally  small  subcutaneous  ha^morr- 
Imges  have  appeared  on  the  hands.  A  ha.'mic 
murmur  developed  at  the  pulmonary  cartilage 
shortly  after  admission,  and  the  pulse  has  at 
times  been  intermittent.  The  gastric  contents 
have  persistently  shown  an  absence  of  free 
acids.  The  weight  has  increased  to  133 
pounds. 

The  treatment,  in  addition  to  cardiac  tonics, 
consisted  in  the  administration  of  arsenic,  be- 
ginning with  m.  ii.  Fowler's  solution  t.i.d,  and 
increasing  the  dose  by  m.  i.  daily  until  m.  xvi. 
were  given,  when  it  was  omitted  for  two  days 
on  account  of  vomiting,  and  then  recommenced 
with  a  dose  m.  xv.  t.i.d.,  which  has  been  con- 
tinued to  the  present. 

A  glycerin  extract  of  bone  marrow  in  doses 
of  3ii.  to  3iii.  t.i  d.  was  begun  on  March  ist  in 
addition  to  the  arsenic.  The  results  of  treat- 
ment have,  as  in  the  first  case,  been  unsatisfac- 
tory, the  blood  conditions  being  precisely  the 
same  as  on  admission. 

P.S. — This  patient  developed  great  anasarca 
of  the  lower  extremities,  double  hydrothorax 
and  dyspnoea,  obviously  of  cardiac  origin,  and 
died  April  7  th. 

Autopsy  performed  by  Dr.  Wyatt  Johnston 
showed  a  moderate  quantity  of  fluid  in  the 
pleural  cavities.  The  heart  was  ranch  enlarged 
on  both  sides  and  the  right  distended  with 
blood.  QEdema  and  slight  emphysiema  of  the 
lungs. 

Kidneys — Left  slightly  enlarged,  capsules  ad- 
herent and  a  few  cysts  present. 

Prostate  presented  two  adenomata  projecting 
into  the  bladder. 

The  liver  was  rather  small,  and  on  section  the 
veins  were  prominent.  The  spleen  was  large 
and  firm. 

The  mucosa  of  the  stomach  was  soft  and  the 
organ  contained  a  pint  of  curdled  matter.  The 
red  marrow  of  sternum,  ribs  and  vertebrae  was 
increased.  On  microscopic  examination  pig- 
ment was  found  about  the  central  vein.  No 
iron  reaction  and  no  pigment  in  peripheral 
zones. 

Stomach  on  microscopic  examination  showed 
a  loss  of  the  superficial  part  of  the  mucosa 
from  post-mortem  digestion,  but  the  glands  in 
the  deeper  portion  of  the  mucosa  were  normal 
in  every  respect,  presenting  neither  atrophy, 
increase  in  connective  tissue,  nor  alteration  of 
the  epithelium. 

The  lemon  tinge  of  skin  present  in  both 
cases  was  extremely  suggestive  of  pernicious 
anaemia. 

The  diagnosis  of  the  first  case  rests  chiefly 
on  the  condition  of  the  blood,  together  with  an 
absence  of  any  of  the  usual  causes  for  a  secon- 


dary ansmiia.  The  blood  counts  invariably 
showed  a  relative  excess  of  hi'cuioglobin,  a  sign 
which  is  usually  present  in  the  pernicious  form 
of  amemia.  The  marked  irregularity  in  shape 
and  size  without  increase  of  the  white  cells  is 
also  very  characteristic.  The  presence  of 
nucleated  red  cells,  which  has  been  insisted  on 
by  some  as  essential  in  the  diagnosis  of  per- 
nicious anjemia,  are  in  my  experience  rather 
the  exception  than  the  rule.  In  five  cases 
under  my  observation  in  which  they  have  been 
carefully  looked  for  they  were  present  only  in 
one.  The  splenic  enlargement  present  in  this 
case  is  rather  exceptional,  although  it  is  a  well 
recognized  feature  of  the  disease. 

The  presence  of  pathological  urobilin  is  an 
important  diagnostic  feature,  and  urine  of  high 
color  and  low  sp.  gr,  is  also  suggestive  ot  the 
condition. 

The  absence  of  free  hydrochloric  acid  from 
the  gastric  contents  at  first  raised  the  question 
of  the  possibility  of  carcinoma  of  the  stomach 
being  the  cause  of  anaemia.  The  absence  of 
pain,  of  tumor,  of  hsematemesis  and  of  per- 
sistent vomiting,  together  with  the  relative 
embonpoint  of  the  patient,  were  decidedly 
against  this  view,  and  the  absence  of  progres- 
sive emaciation  during  the  past  three  and  a 
half  months  also  bear  out  the  original  diagnosis. 
A  leucocytosis,  again,  which  is  commonly  pre- 
sent in  cancer,  was  here  absent. 

In  the  second  case  the  diagnosis  of  perni- 
cious anaemia  in  a  patient  with  arteiial  sclerosis 
and  dilated  heart,  made  during  life,  was  not 
borne  out  by  tha  results  of  the  autopsy.  The 
deposit  of  iron  in  the  liver  was  absent,  and 
only  the  ordinary  senile  pigmentation  in  the 
centre  of  the  lobule  was  found. 

Hiifler,  quoted  by  Ewald,  records  a  number 
of  cases  wheie  hydrochloric  acid  was  absent  in 
cases  of  valvular  disease,  and  it  may  be  that  this 
was  the  cause  here.  Such  a  degree  of  antemia, 
with  marked  poikilocytosis  must,  however,  be 
unusual  in  cardiac  disease,  and  the  kidneys 
were  so  slightly  affected  that  the  antemia  of 
renal  disease  was  hardly  possible.  Whether 
any  relation  between  anaemia  and  absence  of 
hydrochloric  acid  exists  can  only  be  deter- 
mined by  further  observation.  The  case  under 
consideration  is,  however,  not  one  of  anaemia 
associated  with  atrophy  of  the  gastric  tubules. 
The  absence  of  such  an  important  consti- 
tuent as  hydrochloric  acid  does  not  seem  to 
have  caused  any  serious  gastric  disturbance  in 
either  case.  We  may  perhaps  assume  that 
compensation  is  effected  by  the  pancreas. 

In  the  first  case,  nausea,  occasional  vomiting 
and  heart-burn  began  apparently  coincidently 
with  the  onset  of  the  symptoms  of  anaemia,  and 
in  the  second  case  such  symptoms  were  entire- 
ly absent. 

It  is  well  known  that  the  weight  and  gen- 
eral nutrition  are    usually  retained   in  the  sub- 


2/0 


THE   CANADA   MEDICAL   RECORD. 


ject  of  pernicious  anaemia,  and  the  loss  of 
weight  occurring  in  these  cases  may  be  satis- 
factorily accojnted  fur  by  the  absence  of 
gastric  digestion. 

The  association  of  atrophy  of  tlie  gastric 
glands  and  a  grave  form  of  anremia  has  been 
recognized  for  a  number  of  years.  First  point- 
ed out  by  Austin  FHnt,  this  observation  has 
been  confirmed  by  Fenwick,  by  Osier  and 
Henry  and  many  others,  and  the  fact  is  now 
well  established.  There  has  been  and  still  is 
considerable  divergence  of  opinion  about  the 
interpretation  of  these  observations.  Many 
observers  regard  the  atrophy  as  a  consequence 
and  result  of  the  ansemia,  and  as  having,  there- 
fore, but  little  bearing  on  the  condition. 
There  are  others,  however,  Flint  and  Fenwick 
among  the  number,  who  do  not  hesitate  to 
state  that  the  atrophy  is  primary  and  the 
anjemia  secondary,  so  that  the  term  idiopathic 
anaemia  is  not  strictly  correct  in  such  cases. 
Osier  and  Henry,  for  instance  {Am.  Jour.  Med. 
Sci.,  1886),  relate  a  case  with  aU  the  clinical 
features  of  pernicious  anemia,  including  the 
blood  changes,  in  which  extensive  atrophy  was 
found  in  the  gastric  tubules  at  autopsy.  The 
onset  of  the  malady  was  preceded  for  years  by 
loss  of  flesh,  indigestion  and  vomiting,  and  the 
authors  therefore  conclude  that  the  gastric 
condition  was  primary.  Hunter  (^British  Med. 
/.,  1890-92)  records  a  case  in  which  atrophy  of 
the  gastric  glands  was  found  after  death  in  a 
case  of  pernicious  anaemia,  and  he  brings  for- 
ward arguments  based  on  pathological  investi- 
gation and  urinary  analysis  to  show  that 
abnormal  fermentation  in  the  gastro-intestinal 
tract  may  generate  certain  toxic  agents  which 
have  a  deleterious  action  on  the  blood,  and 
induce  a  process  of  blood  destruction. 

As  hydrochloric  acid  is  the  natural  antiseptic 
agent  of  the  stomach,  its  absence  would  natur- 
ally favor  these  abnormal  chemical  changes. 
Without  dwelling  on  this  point,  Hunter  has 
made  a  valuable  addition  to  our  knowledge  by 
pointing  out  that  pathological  urobilin  is 
frequently  present  in  large  quantities  in 
pernicious  anaemia.  As  this  substance  is 
derived  from  blood  pigment,  its  presence 
in  *  the  urine  indicates  excessive  destruc- 
tion of  blood.  Hunter  regards  the  pre- 
sence of  this  substance  as  of  much  diagnostic 
value.  It  may  be  detcted  by  the  spectroscope, 
in  which  it  shows  a  broad  dark  band  lying 
close  to  the  line  F,  and  also  a  considerable 
absorption  of  the  outer  part  of  the  blue 
spectrum,  jaksch  also  recommends  Huppert's 
test,  performed  by  collecting  the  precipitate 
formed  by  the  addition  of  milk  of  lime  to  urine, 
adding  alcohol  and  a  drop  or  two  of  dilute 
sulphuric  acid  in  a  test  tube,  and  boiling.  On 
settling,  the  supernatant  liquid  shows  a  red 
tint.  Hunter  recommends  adding  a  solution 
of  zinc   chloride  in  alcohol  to    urine,  when   a 


green  fluorescence  develops.  This  test,  how- 
ever, seems  inferior  in  delicacy  to  the  others, 
and  has  been  negative  in  the  above  cases  on 
the  few  occasions  in  which  it  was  employed. 

If  we  admit  the  frequent  occurrence  of 
gastric  atrophy  in  pernicious  anaemia,  we  would 
a  priori  expect  an  absence  of  free  hydro- 
chloric acid  in  the  gastric  juice. 

From  a  rather  hurried  search  through  various 
reports  of  such  cases,  I  do  not,  however,  find 
this  point  referred  to  except  by  Eisenlohr. 
T\\\'=>wx\lQ.x{Dcutsch  Med.  JFot /i,  jSg2)  relates 
a  case  in  which  this  symptom  was  present  in 
pernicious  aneemia,  and  in  which  there  was 
atrophy  of  the  gastric  glands. 

That  hydrochloric  acid  should  be  absent  in 
two  cases  of  grave  ansmia  seems  rather  re- 
markable, and  it  would  prove  of  interest  to 
know  in  what  proportion  of  cases  this  sign  is 
present.  In  the  absence  of  post-rnortem  ex- 
amination its  significance  is  somewhat  doubtful, 
as  the  acid  may  be  absent  in  a  number  of  con- 
ditions. Recognizing  the  fact,  however,  that 
atrophy  of  the  gastric  tubules  is  a  frequent 
accompaniment  of  pernicious  anaemia,  it  is 
highly  suggestive  of  the  association  of  the  two 
conditions. 

We  are  as  yet  hardly  in  possession  of  sufii- 
cient  facts  to  state  whether  we  can  recognize  a 
distinct  gastric  type  of  tlie  disease,  but  it  can 
readily  be  seen  that  such  a  view. may  have  an 
important  bearing  on  treatment.  If  we  accept 
Hunter's  view  that  abnormal  fermentation  with 
the  formation  of  ha^molytic  agents  is  going  on 
in  the  gastro-intestinal  tract,  we  may  find  that 
the  adminstration  of  intestinal  antiseptics  is  of 
primary  importance,  and  indeed  Gibson  has 
recorded  a  case  in  which  such  a  line  of  treat- 
ment was  followed  by  marked  improvement. 

Dr.  F.  W.  Camphell  thought  the  manner 
of  administration  might  have  something  to  do 
with  the  results  obtained  from  arsenic  in  many 
cases.  He  thought  it  was  Dr.  Seguin  who  first 
called  attention  to  the  fact  that  arsenic,  when 
given  in  small  doses  frequently  repeated,  was 
much  more  likely  to  be  followed  by  beneficial 
results  than  when  given  in  the  usual  manner, 
three  or  four  times  daily.  Dr.  Seguin,  of 
course,  was  speaking  of  chorea,  and  of  the 
soundness  of  his  advice  in  this  respect  the 
speaker  had  had  personal  experience  in  several 
cases.  In  like  manner,  however,  he  believed 
that  in  pernicious  anaemia  the  effect  of  giving 
the  drug  every  two  hours,  and  gradually  increas- 
ing the  dose,  ought  to  be  tried. 

Dr.  D.  F.  GuRD  referred  to  the  treatment 
by  bone  marrow  and  strophanthus  which  he 
recently  observed  in  Edinburgh. 

Dr.  McCoNNELL  had  always  believed  that 
the  presence  of  nucleated  red  corpuscles  was 
necci-sary  before  the  case  could  be  considered 
one  of  pernicious  anaemia.  He  thought  that 
the  explanation  given  of  the  absence  of  relative 


THE   CANADA   MEDICAL   RECORD. 


271 


increase  in    the  hcemoglobin  in   one  case,  viz., 

the  smaller  size  of  the  red    corpuscles,    was  a 

vciy  interesting    point. 
Resuscitation    of     a    ncw-/>or/i      Child    by 

Rhythmic      Traction      on      the    Tongue. — Dr. 

Kenneth  Cameron  read  a  report  of  the  case, 

as  follows  : — 

Rhythmic  traction  on  the  tongue  as  ame.ms 
of  resuscitating  the  asphyxiated,  especially  the 
drowned,  seems  to  have  been  first  suggested 
by  Laborde,  of  Paris,  in  a  paper  in  Lc  Bulletin 
MedicaL  January,  1893.  Since  then  a  number 
of  French  writers  have  testified  to  the  value  of 
the  metliod,  not  only  in  drowning,  but  in  the 
resuscitation  of  the  newborn  and  in  asphyxia  or 
apparent  death  from  many  other  causes.  Hardly 
any  communications  on  the  subject  have  ap- 
peared from  English  sources. 

I  report  the  following  case  to  bring  the 
meihod  before  the  notice  of  the  members  of  the 
Society  : — 

On  Friday,  February  ist,  I  was  called  to  see 
Mrs.  L.,  who  v/as  in  labor.  Ihe  membranes 
had  ruptured,  and  a  large  quantity  of  amniotic 
fluid  had  drained  away.  Both  feet  were  present- 
ing in  the  vagina,  and  after  an  unsuccessful 
attempt  to  replace  them  and  perform  cephalic 
version,  extraction  was  proceeded  with.  No 
difficulty  was  experienced  in  delivering  the 
body,  but  there  was  a  good  deal  of  delay  in  the 
birlh  of  the  head,  the  cord  having  ceased  to 
beat  some  little  time  before  the  head  was  born. 
The  child,  after  birth,  was  limp  and  cyanotic  ; 
artificial  respiration,  slapping,  applications  of 
heat  and  cold  alternately,  kept  up  for  about  ten 
minutes  failed  t  ■>  cause  a  respiratory  movement, 
an  occasional  faint  flutter,  however,  could  be 
felt  over  the  cardiac  region. 

Rhythmic  traction  on  the  tongue  was  then 
practised.  The  child  being  placed  well  over 
on  its  right  side,  the  tongue  vvas  gently  seized 
by  a  pair  of  Pean's  forceps,  and  forcibly  drawn 
forward  and  then  forcibly  shoved  back  as  far 
as  possible  in  both  directions.  This  was  kept 
up  at  the  rate  of  about  30  or  a  little  more  ])er 
minute.  Hardly  half  a  minute  had  elapsed, 
after  beginning  the  traction,  before  the  child 
gave  an  inspiration,  in  about  another  half 
minute  a  second  one  followed  ;  after  that  they 
became  gradually  more  frequent,  and  soon  the 
child  began  to  cry.  The  child  has  since  been 
perfectly  well. 

This  very  marked  effect  produced  so  rapidly, 
and  by  such  a  simple  manoeuvre,  impressed 
upon  me  the  very  great  value  of  the  method, 
and  that  it  is  the  one  which  should  be  made 
use  o[ first  in  all  such  cases,  or  in  any  form  of 
apparent  death. 

Dr.  Lafleur  remarked  that  Dr.  Cameron  's 
seemed  to  be  one  of  the  earliest  reports  in 
English  of  this  procedure.  His  method  differed 
from  that  of  Laborde's,  who  advocated  making 
only  twelve  to  fifteen  tractions  per  minute. 


Dr.  HiNGSTON  said  it  seemed  to  him  that  the 
virtue  of  the  process  lay  in  pulling  the  tongue 
forward.  Shoving  it  backward  was  not  only 
useless,  but  might  be  even  injurious.  Pulling 
the  tongue  forward  and  then  relaxing  it  had 
been  a  method  in  use  as  long  as  he  could 
remember. 

Dr.  Lafleur  took  exception  to  Dr. 
Hingston's  sweeping  condemnation  of 
Lahorde's  method  without  being  sufliciently 
acquainted  with  the  details.  If  he  had  read 
Laborde's  article,  he  would  find  the  different 
procedures  were  based  on  sound  physiological 
principles,  and  that  the  pushing  backwards  of 
the  tongue  was  a  very  essential  part  of  the 
process. 

Dr.  Mills  thought  the  method  might  be 
explained  by  reflex  action. 

Dr.  Cameron,  in  reply,  said  he  had  not 
remembered  Laborde's  exact  experiment  at  the 
time  ;  but  he  tried  what  he  thought  would  be 
the  natural  number  of  respirations  to  the  minute 
in  a  new  born  child. 


Stated  Meeting^  March  22nd,  1895. 

G.  P.  GiRDwooD,  M.D.,  President,    in  the 
Chair. 

Aneurism  of  the  Femoral  Artery  Treated  by 
Ligature  of  the  External  Iliac  Artery — Dr. 
Bell  showed  a  man  who  had  been  the  subject 
of  an  aneurism  of  the  common  femoral  artery, 
which  had  been  treated  by  ligation  of  the  ex- 
ternal iliac.  The  patient,  a  young  man  only 
32  years  of  age,  had  never  done  any  hard  work, 
having  been  the  caretaker  of  a  private  car  on 
the  Canadian  Pacific  Railway.  He  had  had 
syphilis  seven  or  eight  years  before,  and  there 
was  no  account  of  any  systematic  treatment 
having  been  employed.  He  had  suffered  from 
the  aneurism  for  several  months,  until,  when  he 
came  under  observation,  it  was  apparent  as  a 
large  pulsating  tumor  extending  right  up  to 
Poupart's  ligament.  Ligature  of  the  external 
iliac  was  carried  out  in  the  ordinary  way  with 
great  ease  and  satisfaction.  Some  interesting 
facts  developed  in  connection  with  the  restor- 
ation of  the  circulation  afterwards.  The  oper- 
ation was  performed  on  Monday,  January  28th. 
On  the  following  Wednesday  week  (February 
7th)  pulsation  was  distinctly  evident  in  the 
anterior  and  posterior  tibial  arteries.  As  to  the 
aneurism,  the  pulsation  ceased  completely  in 
it  at  the  time  of  the  operation,  but  commenced 
again,  however,  about  ten  days  afterwards,  and 
this  was  again  followed  by  a  gradual  decline 
until  the  condition  then  present  was  reached. 
A  little  pulsation  might  be  felt  beneath  and  at 
the  inner  border  of  what  was  once  the  aneur- 
ismal  mass,  but  which  vvas  much  contracted. 
This  pulsation,  Dr.  Bell  thought,  came  from 
some  of   the  enlarged  collateral  arteries  in  the 


2/2 


THE   CANADA   MEDICAL   RECORD. 


neighborhood.  In  answer  to  Dr.  Girdwood> 
as  to  why  there  should  be  so  much  pulsation 
then  present,  Dr.  Bell  remarked  that  the  pulsa- 
tion was  completely  arrested  ;  t  the  time  oi  the 
operation  ;  it  had  returned  at  the  end  of  ten 
days.  The  pulsation,  at  the  time  the  patient 
was  shown,  he  did  not  believe  was  in  the 
tumor  proper,  but  from  some  source  below,  and 
brought  about  by  the  efforts  of  the  system  to 
establish  the  collateral  circulation. 

Experimental  Cachexia  Strumipriva. — Dr. 
Wesley  Mills  gave  the  subsequent  history  of 
the  case  presented  at  the  previous  meeting. 
The  day  after  the  dog  was  shown  there  had  been 
moderate  dyspnoea,  cretinism,  twitching  and 
fibrillary  contractions.  Emaciation  gradually 
developed,  and  he  died  on  the  twelfth  day  after 
the  operation  was  performed. 

Experiments  on  Cerebral  Localization. — Dr. 
Wesley  Mills  exhibited  a  mongrel  dog  about 
three  months  old,  from  which  he  had  about  ten 
days  before  removed  the  whole  of  the  cortical 
area  around  the  crucial  sulcus,  which  function- 
ally corresponded  pretty  well  to  the  fissure  of 
Rolando  in  man  and  the  monkeys.  The  areas 
for  the  movements  of  the  opposite  fore  and  hind 
limbs  and  head  movements  had  first  been  deter- 
mined by  electrical  stimulation  of  the  cortex, 
and  the  whole  area  and  more  than  that  had  been 
removed,  including  a  little  of  the  white  matter 
beneath  on  the  right  side.  The  only  obvious 
symptoms  present,  in  the  dog  shown,  were 
slightly  ataxic  movements  of  the  opposite  limbs, 
especially  of  the  front  legs.  There  did  not 
seem  to  be  any  appreciable  weakening  of 
muscles,  at  all  events  no  real  paralysis,  nor 
were  there  any  sensory  symptoms,  unless  some 
partial  loss  of  tactile  and  muscular  sensibility 
on  the  affected  side.  The  dog  was  able  to 
stand  and  walk  in  half  an  hour  after  the  oper- 
ation, and  had  always  been  lively  and  well, 
never  showing  greater  changes  than  when 
exhibited.  An  ether  and  chloroform  mixture 
was  the  anoesthetic  used.  There  was  consider- 
able loss  of  blood  during  the  operation,  but  the 
wound  healed  rapidly.  Antiseptic  precautions 
were  used,  but  not  to  the  same  extent  as  in  a 
case  of  operation  on  man. 

Dr.  Mills  proposes  to  operate  on  the  corres- 
ponding part  of  the  brain  on  the  other  side 
shortly,  and  to  show  the  dog  again. 

Dr.  Mills  also  exhibited  a  cat  (mature)  on 
which  he  had  performed  a  similar  operation. 
While  the  cat  could  walk  very  well,  there  was 
a  decided  tendency  in  the  opposite  paw  to  turn 
under,  analagous  to  occasional  "  wrist-drop." 
She  was  also  blind  and  deaf  on  the  opposite 
side,  and  very  distinctly  deficient  in  tactile 
sensibility  on  the  same  side  as  the  paresis. 
The  cat  had  been  very  dull  and  had  taken  food 
badly.  There  was  a  strong  suspicion  that  she 
was  partially  wanting  in  the  sense  of  smell. 
Unfortunately  this  case  had  been  complicated 


by  suppuration  in  the  wound.  However,  Dr. 
Mills  will  report  on  the  case  later.  In  the 
meantime,  he  thought  it  better  to  draw  few  con- 
clusions as  regards  the  subject  of  cortical  local- 
ization in  these  species  of  animals.  The  sub- 
ject of  localization  was  by  no  means  in  its  final 
stage,  he  believed,  and  he  might  state  that 
after  much  work  he  was  obliged  to  hold  that 
Ferrier's  localization  was  neither  complete  nor 
wholly  correct  for  all  the  varieties  of  animals 
on  which  he  had  reported. 

Dr.  James  Bell  would  like  to  ask  if  Dr. 
Mills  had  definitely  located  the  motor  areas 
first,  and  removed  accordingly.  If  not,  what 
reason  had  he  for  believing  that  he  had  removed 
the  whole  of  the  motor  area  or  areas  ?  The 
deductions  drawn  from  this  were,  he  thought, 
at  variance  with  our  experience  in  human  sub- 
jects, in  whom  the  motor  areas  are  well  recog- 
nized, and  their  removal  causes  complete 
paralysis.  He  had  removed  a  portion  of  the 
cortex  of  the  brain  of  a  man  suffering  from 
epilepsy  ;  he  removed  the  hand  area,  after  first 
locating  it  accurately,  and  a  result  was  a  defin- 
ite paralysis  of  the  hand.  The  man  died  after- 
wards from  the  original  lesion,  which  was  not 
discovered  at  the  time  of  the  operation,  viz.,  a 
cyst  of  the  anterior- lobe,  which  had  ultimately 
developed  into  an  abscess  of  the  ventricle. 
Removing  the  motor  area  of  the  muscles  of  the 
hand,  of  course,  had  nothing  to  do  with  the 
treatment  of  the  diseased  condition,  but  was 
done  with  the  object  of  arresting  the  convulsive 
attacks  which  always  began  in  the  hand. 

Sarcoma  of  the  Ileum:  Resection  with  the 
Murphy  Button  ;  Death. — Dr.  James  Bell 
aeported  the  case,  that  of  a  woman  27  years  of 
age,  who  has  suffered  five  years  from  diarrhoea 
and  emaciation,  commencing  immediately  after 
the  birth  of  a  child.  She  gradually  failed 
in  health  ;  lately  she  suffered  from  some  obs- 
tructive symptoms,  and  a  tumor  developed 
on  the  right  side  of  the  abdomen  and  could  be 
moved  freely  about.  An  operation  was  per- 
formed by  Dr.  Gardner,  who  thought  it  was 
connected  with  the  uterus  or  adnexa.  No  at- 
tempt was  then  made  to  remove  it.  The  second 
operation  was  performed  on  January  22nd  ;  the 
distal  portion  of  the  bowel  was  quite  small  and 
the  proximal  portion  was  much  dilated  with  a 
thickened  hard  wall.  There  was  considerable 
difiicully  in  fastening  the  Murphy  button  into 
the  dilated  proximal  portion.  The  patient 
rallied  well  after  the  operation,  and  did  typically 
well  from  Monday,  the  day  of  the  operation, 
until  the  following  Sunday  morning,  or  the  end 
of  the  sixth  day.  Then  she  complained  of  sharp 
shooting  pains  in  the  vagina  ;  nothing  could  be 
detected,  however.  At  10  o'clock  she  fell  into 
a  collapsed  condition,  with  extreme  pain,  and 
died  about  2  o'clock  in  the  afternoon.  'J'his 
result  was,  of  course,  due  to  perforation  and 
peritonitis.     The   peculiar   feature  in  the  case 


THE  CANADA   MEDICAL   RECORD. 


273 


was  the  length  of  time  ehipsing  before  the  per- 
foration took  place.  This  was  briefly  the  his- 
tory of  the  case. 

Dr.  Adami  exhibited  the  specimen,  and  said 
that  the  case  here  brought  forward  presented 
not  a  few  points  of  interest.  An  exploratory 
incision  had  been  made  by  Dr.  Gardner,  a 
small  mass  of  involved  gland  was  removed, 
and  this  on  section  presented  in  general  the 
appearance  of  a  moderately  large  round- 
celled  sarcoma.  On  further  examination  what 
seemed  to  be  a  locular  arrangement  could  be 
made  out ;  between  rounded  or  roughly  poly- 
gonal masses  of  the  sarcoma  cells  could  be 
seen  very  delicate  bands  of  interstitial  tissue. 
The  specimen,  in  fact,  was  undistinguishable 
from  sections  of  what  turned  out  to  be  a  rapidly 
proliferating  carcinoma  of  the  prostate  which  he 
had  brought  before  the  Society  two  years  before. 
The  age  of  the  patient,  27  years,  was,  however, 
against  a  diagnosis  of  this  nature,  nevertheless 
he  felt  it  unwise  to  give  an  absolute  opinion. 
At  the  operation  the  primary  growth  was  re- 
moved and  the  ileum  resected.  The  growth 
was  clearly  a  sarcoma,  a  round-celled  sarcoma 
of  the  submucosa  infiltrating  the  muscular  coats 
in  a  characteristic  manner.  The  specimen 
showed  parallel  rows  of  round  cells  passing 
between  the  fibres  of  the  circular  muscles,  and 
secondary  growths  were  evident  both  on  the 
serous  surface  and  in  the  neighboring  lympha- 
tic glands.  It  was  difficult  to  conceive  that  this 
growth  had  been  present,  causing  stenosis  of 
the  ileum  for  the  number  of  years  during  which 
the  subject  had  suffered  from  symptoms  of  in- 
testinal obstruction.  It  would  seem  more  pro- 
bable that  obstruction  had  been  induced  by 
some  other  cause,  and  that  the  malignant 
growth  was  secondary  to  the  chronic  distur- 
bance at  the  point.  As  shown  by  the  specimen, 
the  growth  was  about  three  inches  broad  ;  it 
was  within  one  inch  and  a  half  of  the  ileo-cjecal 
valve. 

The  specimen  of  removed  growth  and  intes- 
tine showed  well  the  great  dilatation  and  hyper- 
trophy of  the  ileum  above  the  growth. 

At  the  autopsy  the  small  intestine  was  found 
shorter  than  Dr.  Adami  had  ever  seen  record- 
ed. Including  the  removed  seven  inches,  the 
total  length  from  duodenum  to  valve  was  under 
eleven  feet.  This  shortening  was  not  only  com- 
pensatory to  the  dilatation,  but  evidently  there 
was  an  absence  of  ileum  proper,  for  the  valvulse 
conniventes  were  continued  in  considerable 
frequency  right  up  to  the  tumor.  Whether 
the  condition  was  congenital,  or  acquired 
through  infantile  or  other  intussusception,  he 
would  not  venture  to  state,  but  suggested  that 
the  latter  condition,  with  subsequent  necrosis 
of  the  invaginated  portion,  would  leave  a  con- 
dition capable  of  entirely  explaining  the  subse- 
quent history,  would  leave,  that  is,  an  annular 
cicatrix  and  narrowing  of  the  gut  which  might 


become  the  seat  of  malignant  growth.  The 
position  of  the  stricture,  close  to  the  ileoca^cal 
valve,  was  wholly  in  favor  of  this  view. 

As  shown  by  the  second  specimen  the 
Murphy  button  had  remained  adherent  save 
towards  the  mesentery.  Here  sloughing  had 
occurred  with  passage  out  of  the  intestinal  con- 
tents on  either  side  of  the  ligatured  mesentery, 
general  peritonitis  had  ensued  and  had  caused 
death. 

The  omentum  was  firmly  adherent  in  the 
middle  line  over  the  old  laparotomy  wound, 
while  in  the  right  iliac  region,  over  the  area  of 
intestinal  resection,  there  was  firm  fibrinous 
adhesion.  Evidently,  until  perforation  oc- 
curred, the  healing  process  had  been  advancing 
very  favorably. 

It  was  worthy  of  note  that  this  case  afforded 
another  illustration  of  the  danger  of  employing 
the  Murphy  button  in  connection  with  a  viscus 
that  had  undergone  chronic  thickening.  The 
thickened  condition  of  the  upper  portion  of 
the  intestine  as  compared  with  the  thinness  of 
the  part  below  the  tumor  was  here  extremely 
well  marked. 

Suppurative  Arithitis  due  to  Typhoid  Ba- 
cilhis. — Dr.  C.  F.  Martin  reported  this  case 
as  follows  : 

Cases  of  typhoid  fever,  in  which  complica- 
tions of  a  suppurative  nature  have  been  found, 
can  no  longer  be  placed  in  the  category  of  rare 
affections  ;  yet  so  seldom  are  the  etiological  fac- 
tors of  these  secondary  conditions  identical 
with  the  primary  cause  of  the  disease,  that  any 
new  case  is  perhaps  properly  placed  on  re- 
cord. 

The  present  report  concerns  a  man,  P.  C  , 
a^t.  34,  who  entered  Dr.  Stewart's  wards  at  the 
Royal  Victoria  Hospital  on  September  25th, 
1894,  complaining  of  headache,  fever  and  loss 
of  appetite,  and  presenting  the  usual  distinct 
signs  of  enteric  fever.  He  gave  the  ordinary 
history  of  the  early  stages  of  that  disease,  and 
on  admission  seemed  to  have  reached  the 
eighth  day  of  the  fever. 

During  the  first  ten  days  of  his  illness  in  the 
hospital,  favorable  progress  occurred  ;  but  on 
the  eighteenth  day  recrudescence  supervened, 
and  the  temperature  continued  to  rise  till  the 
29th  day,  by  which  time  the  highest  point  was 
attained. 

Three  days  later  (/.£?.,  in  the  earliest  days  of 
defervescence)  the  patient  complained  of  some 
pain  and  tenderness  in  right  wrist  joint,  in- 
creased by  movement.  In  forty-eight  hours 
there  developed  other  signs  of  acute  inflamma- 
tion— redness,  swelling,  heat  and  greatly 
impaired  function — the  visible  signs  appearing 
both  in  front  and  behind  the  joint. 

Hot  fomentations  were  applied,  and  a  few 
days  later  a  splir.t  and  bandage  adjusted  to 
keep  the  joint  at  rest.  For  the  following  two 
weeks   the  temperature  gradually  subsided  to 


2/4 


THE   CANADA   MEDICAL   RECORD. 


normal,  and  then  suddenly  (on  the  foity-eighth 
day)  again  rose  to  loi".  The  splint  was  forth- 
with removed,  revealing  a  tender,  fluctuating 
tumor  all  about  the  wrisi  joint,  and  manifest 
ing  noevid:nce  of  improvement  in  the  local 
condiiion. 

\\iih  a  view  to  ascertaining  th^  nature  of  the 
fluid  within,  a  hypodermic  syringe  wjs  em- 
ployed with  the  usual  aseptic  j)recautions  and 
half  a  drachm  of  thi>  pus  removed.  From  this 
a  series  of  culiures  on  broth,  gelatine  and  agar 
was  made,  and  the  presence  in  each  case  of 
but  one  form  of  bacteria  demonstrated,  viz.. 
that  corresponding  in  size  and  form  to  the 
bacillus  of  enteric  fever.  Further  investigations 
showed  its  extreme  mobility,  that  it  produced 
no  acid  reaction  on  litmus  agar,  and  that  when 
grown  in  a  bioth  medium  contai.iing  calcium 
carbonate,  no  gases  were  formed.  1  here  was 
further  no  sign  of  fermentation  in  a  growth  of 
the  bacteria  in  2  i)er  cent,  lactosed  broth.  We 
were  thus  enabled  to  exclude  the  presence  of 
bacillus  coli  comuuiuis  as  a  complicating  fac- 
tor. 

Subsequent  to  this  small  aspiration  gradual 
improvement  ensued,  though  two  weeks  later 
there  was  stiil  a  small  quantity  of  fluid  left. 
Accordingly,  for  a  second  time,  the  hypoder- 
mic was  introduced  and  a  small  amount  of 
bloody  pus  withdrawn.  A  rabbit  inoculated 
with  this  fluid  manifested  no  ill  effects.  This, 
we  believed,  could  be  readily  explained  from 
the  fact  that  as  on  a  culture  medium,  so  here 
the  bacilli  had  grown  old  and  hence  innocuous 
to  our  animal. 

One  week  later  patient  left  the  hospital,  his 
wrist  being  almost  completely  restored  to  its 
normal  condition. 

We  have  recorded  this  case  not  only  because 
of  its  interest  in  verifying  the  pyogenic  proper- 
ties of  Eberth's  bacillus,  but  also  because  in 
the  fairly  extensive  literature  at  our  command 
we  were  unable  to  discover  any  similar  case  iii 
which  a  suppurative  arthritis  complicating  ty- 
phoid fever  was  induced  solely  by  the  bacillus 
of  that  disease. 

During  the  course  of  our  investigations, 
however,  Swiezynski,  in  the  November  number 
oUCentralblatt fiir  Bakkriolo^ic^  has  recorded 
a  somewhat  similar  instance,  though  merely  of 
a  periarticular  inflammation,  and  the  observer 
further  notes  the  uniqueness  of  his  case  and  his 
inability  to  find  a  parallel  in  the  literature  at 
his  disposal.  That  oidinary  pyogenic  organisms 
are  responsible  for  most  of  the  suppurations  in 
enteric  fever  has  been  amply  demonstrated  by 
Vincent,  who  further  pointed  out  that  wherever 
streptococci  were  associated  with  the  typhoid 
germ  the  prognosis  is  always  grave.  On  the 
other  hand,  the  association  of  staphylococci 
could  not  be  regarded  as  an  unfavorable  sign 
so  far  as  recovery  is  concerned. 

The  correctness  of  these  views  is  perhaps 


strengthened  by  the  experience  met  with  at  the 
Royal  Victoria  Hospital,  where  a  patient  in 
whom  streptococcus  infection  was  superadded 
to  his  enteric  fever  succumbed  to  the  disease. 
On  the  other  hand,  the  n  irnerous  cases  in  which 
we  have  found  slaphyjococci  in  various  com- 
plications of  typhoid  fever  have  all  terminated 
in  recovery. 

As  regards  the  treatment  of  suppurations 
occurring  secondary  to  enteric  fever,  it  has  been 
urged  by  Dr.  Meisenbach,  of  St.  Louis,  that  in 
cases  where  Eberth's  baciilus  is  the  sole  cause 
of  the  abscess  formation,  exactly  the  same  sur- 
gical treatment  is  required  as  in  cases  where 
pus  arises  from  infection  with  ordinary  pyoge- 
nic bacteiia.  However,  if  it  be  true  that  a 
fresh  growth  of  typhoid  bacilli  when  inoculated 
into  rabbits  is  fatal,  and  that  the  same  growth 
a  few  hours  old  loses  entirely  this  virulence, 
could  not  the  same  apply  to  the  abscess  forma- 
tions in  the  human  body?  In  other  words, 
where  Eberth's  bacillus  alone  is  the  sole  factor 
in  producing  suppuration,  its  virulence  is  so 
rapidly  lost  that  the  mere  removal  of  the  me- 
chanical and  chemical  irritation,  e.g.,  by  ordi- 
nary aspiration,  might  suffice  for  treatment 
wi'.hout  other  operative  interference.  In  our 
own  case,  although  pus  was  present  in  consi- 
derable quantity,  there  was  never  any  tenj;iency 
to  pointing  of  the  abscess,  and  its  whole  cha- 
racter after  ti  e  first  few  days  took  on  the  appear- 
ance of  a  chronic  affectio  \  in  which  all  signs 
of  active  progress  had  disappeared. 

Dr.  George  A.  Brown  had  had  under  his 
care  the  same  case  of  arthritis  reported  by  Dr. 
Martin.  After  leaving  the  hospital  his  a.-thritis 
had  become  aggravated,  and  for  a  long  time  it 
was  very  severe.  He  had  introduced  a  hypo- 
dermic needle,  but  could  obtain  no  matter  from 
the  joint,  and  after  trying  a  great  many  things 
he  finally  put  it  up  in  a  plaster  of  Paris  dressing, 
and  kept  it  there  for  a  month.  On  removing 
it  there  was  still  a  great  deal  of  inflam  nation 
in  the  joint,  so  he  replaced  the  plaster.  At 
that  time  it  was  still  in  plaster-,  but  the  man 
was  able  to  attend  to  his  work.  He  applied 
the  plaster  from  a  little  below  the  wrist  joint 
to  the  elbow. 

RhyUimic  Traction  of  t/ie  Toii^^uc — Dr. 
Mills  gave  an  account  of  an  experiment  he 
had  made  on  a  very  young  kitten,  which,  he 
thought,  threw  so:nc  light  on  the  real  nature  of 
rhythmic  traction  of  the  tongue  as  a  means  of 
resuscitation  in  animals  threatened  by  death 
from  asphyxia. 

A  kitten,  on  whose  brain  he  had  been  oper- 
ating, succumbed  to  ether.  \\.  once  rhythmic 
traction  of  the  tongue  was  begun,  and  after  20 
to  30  seconds  a  single  resi)intion  was  taken  : 
after  a  longer  period  no  respiration  followed 
this  "procedure  till  ihc  skin  over  chest  was 
j)inched,  when  another  gasp  followed.  The 
method  was  still  further  tried  to  no  purpose,  till 


THE  CANADA   MEDICAL  RECORD. 


275 


tlie  face  was  sponged  with  cold  water,  when 
one  or  two  gisps  followed.  It  seemed  to  him 
that  reflex  action  was  plainly  the  only  way  to 
explain  these  results.  The  animal  was  not 
revived  in  this  case,  as  the  sphincter  had  relax- 
ed and  urine  ha  1  been  pa;5sed,  which  was  in  his 
experience  a  sign  of  death  in  the  lower  animals 
at  all  events. 

Some  Interesti/ig  Coiiditio/is  Attending  Post- 
Nasal  Growths. — Dr.  H.  D.  Hamilton  read 
a  paper  on  this  subject. 


Stated  Meeting,  April  ^tli,  1895. 

G.  P.  GiRDWooD,  M.D.,  President,  in 
THE  Chair. 

Multiple  Osteo-Myelitis.—Dx.  G.  E.  Arm- 
strong showed  a  man  whom  he  had  treated  for 
this  disease  ;  the  report  is  as  follows  : 

M.  M.,  male,  jet.  25,  admitted  to  Montreal 
General  Hospital  on  November  8,  1894,  com- 
plaining of  pain  in  left  hand  and  arm.  Present 
ailment  began  six  months  ago  by  dull,  aching 
pain  situated  for  the  most  part  in  the  elbow 
and  shooting  up  and  down  the  limb.  Latterly 
there  has  been  swelling  of  the  hand  and  fore- 
arm. 

Personal  history — Native  of  England  ;  in 
Canada  four  years.  Three  years  ago  had 
swellings  (white)  behind  right  ear  and  over 
right  sterno-clavic'dar  joint.  These  burst  after 
five  months.  Entered  hospital,  and  both  sinuses 
were  scraped  out.  The  sterno  clavicular  wound 
healed,  but  mastoid  has  discharged  ever  since, 
and  has  been  scraped  three  or  four  times. 

One  year  ago  swelling  developed  on  right 
hand,  with  pain  and  tenderness.  It  was  opened 
and  treated,  and  eventually  healed,  but  recurred 
in  six  months,  and  was  again  opened.  Five 
years  ago  he  had  venereal  sores,  three  in  num- 
ber, coming  on  two  weeks  after  connection, 
accompanied  by  phimosis,  necessitating  cir- 
cumcision. No  rash,  sore  throat,  or  alopecia, 
but  one  month  later  had  pains  in  bones  and 
joints. 

Family  History — Non-tubercular. 

Present  Condition. — Temperature  ^'^Yz" -, 
pulse  76,  respiration  22.  Fairly  well  nourished, 
sleeps  well.  Complains  of  pains  in  left  upper 
extremity  fiom  hand  to  just  above  elbow. 
Left  forearm  is  somewhat  swollen,  especially 
about  wrist  and  elbow.  Tenderness  is  more 
marked  about  the  olecranon.  Pain  on  move- 
ment of  elbow.  No  redness  and  very  little 
heat.  Sinus  in  right  mastoid  discharging  a 
small  quantity  of  icherous  pus.  No  pain  or 
tenderness.  Scars  present  on  riglit  hand  and 
sterno-clavicular  joint. 

Urine  amber,  turbid,  neutral ;  no  albumen 
or  sugar. 

Hot  fomentations  applied  to  left  arm. 

November  16.  Right  arm  painful.  Examin- 
ation shows  tender  point  over  olecranon  ; 
painted  with  tr.  iodi. 


January  2.  Since  last  note  the  condition  has 
steadily  grown  worse  in  the  left  arm,  and  re- 
mains about  the  same  in  the  right.  Hot  fomen- 
tations have  been  continuously  applied,  and 
elevation  by  suspension  tried.  An  orchitis  has 
developed  (Ich),  the  testicle  becoming  the  si'.e 
of  an  orange'. 

January  4.  Upper  part  of  posterior  surface 
of  ulna  and  dorsinu  of  fifth  metacarpal  tre- 
phined. 

Januarys.   Relief  of  pain  ;  some  movement. 

January  10.  Relief  of  pain  in  arm  operated 
on,  and  also  in  the  other  olecranon.  Orchitis 
gone.     Temperature  normal  since  the  6th. 

January  24.  Patient  complains  of  severe  head- 
ache with  nausea.  Arms  not  painful,  lungs 
normal,  temperature  too°. 

January  26.  Temperature  steadily  rising,  to- 
day 102  4-5^.  Headache  and  nausea  increas- 
ed in  severity.  Headache  frontal  on  the  ver- 
tex and  passing  down  behind  the  right  ear. 

January  27.  Examination  of  eyes  shows  con- 
gestion and  blurring  of  discs,  more  marked  on 
the  right  side. 

January  28.  Given  ether,  and  the  tympanum 
cleared  out  through  the  external  meatus  and 
also  by  new  trephining.  Old  sinus  full  of  dark 
purulent  matter,  as  was  also  the  tympanum. 
Brain  membranes  exposed  through  both  open- 
ings in  mastoid. 

January  29.  Better ;  temperature  lower,  head- 
ache less  severe.  Patient  has  slight  cough  and 
rusty  expectoration  ;  lungs  apparently  normal. 

February  i.  Temperature  fallen    to  normal. 

Dr.  Armstrong  said  that  in  these  cases  the 
osteo-myelitis  had  been  proved  to  be  due  to 
different  micro  organisms — the  staphylococcus 
aureus,  the  streptococcus  and  pneumococcus 
had  all  been  cultivated  from  these  lesions. 
Whether  these  organisms  had  all  been  present 
during  the  years  the  disease  was  endured  it 
was  hard  to  say,  but,  in  his  opinion,  the  affec- 
tion had  been  present  for  years,  and  sometimes 
certain  favorable  circumstances  combined  to 
afford  them  an  opportunity  of  rapid  develop- 
ment or  multiplication.  At  the  time  of  speak- 
ing the  patient  was  in  good  health,  better  than 
he  had  been  for  years,  and  there  was  evidently 
no  active  disease  going  on. 

Compound  Depressed  Fracture  of  the  Vault 
of  t lie  Skull. — Dr.  G.  E.  Armstrong  exhibited 
a  man  on  whom  he  had  operated  for  this  con- 
dition.     His  history  was  : 

E.  H.,  JBt.  26,  admitted  March  6ih  to  the 
Montreal  General  Hospital  with  a  depressed 
fracture  of  skull.  Patient  was  struck  by  a 
train  on  day  of  admission.  When  picked 
up  he  was  unconscious,  smelt  strongly  of 
alcohol,  and  tossed  his  arms  about  violently. 
Examination  showed  laceration  of  scalp  extend- 
ing from  left  parietal  eminence  to  left  external 
angular  protuberance,  but  only  involving  the 
superficial  layers.     Depression  in  skull  can  be 


276 


THE   CANADA   MEDICAL   RECORD. 


felt  over  the  same  area.  Pupils  natural,  great 
congestion  of  left  eyelid.  No  subconjunctival 
haemorrhage.     Pulse  slow,  s6. 

March  7.  6.30  p.m.  Still  unconsciou-,  quiet. 
Given  ether.  Incision  cnLirged  and  deepened, 
etc. 

March  ?■'.  Somev/hat  recovered  conscious- 
ness. Asks  for  food,  but  gives  many  names. 
Dressed,  outNide  dressing  only. 

March  9.  Conscious  at  times  ;  irritable,  and 
answers  foolishly.  Sometimes  passes  urine 
and  fcercs  into  bed,  and  at  other  limes  calls  for 
receptacle. 

March  12.  Dressed.  Catgut  drain  slipped 
out  owing  to  sudden  mf)vement  on  part  of 
patient.  Is  irritable  and  requires  holding  dur- 
ing dressing,  otherwise  is  fairly  conscious,  but 
cannot  give  his  name. 

March  14.  In  same  stupid  condition.  Con- 
tinually pokmg  finger  in  under  his  left  eye. 

March  17.  Temperature  rose  suddenly  last 
night  to  loi^"',  this  a.m.  loi.  Patient  wholly 
unconscious.  Both  eyelids  red,  glistening,  and 
oedematous.  Dressed.  O-.derna  of  scalp  and 
forehead  to  the  right  of  wound,  none  on  the 
left.  Irrigated  and  "  catgut  drain  reinserted. 
March  18.  Temperature  remains  up  and 
oedema  still  present.  Dressed.  Fluctuating 
surface  over  area  to  tight  of  wound  ;  opened, 
evacuating  a  large  amount  of  pu=:,  leaving  bare 
bone  and  showing  another  fissure  running 
longitudinally.  No  communication  between 
the  two  wounds  except  by  probe.  Drainage 
tubes  inserted  in  all. 

March  20.  Temperature  lower.  Patient 
again  somewhat  conscious. 

March  21.  Oozing;  dressed;  clearing  up  ; 
wholly  conscious. 

March  25.  Temperature  normal  since  22nd. 
Dressed. 

March  27.  Vp  and  walking  about. 
March  31.   Dressed. 

Dr.  Armstrong  described  his  operation  as 
follows  :  He  elevated  the  bone,  and  after 
Avashing  out  the  wound  found  no  evidence  of 
injury  beneath  the  membranes.  The  bone 
was  then  replaced  in  small  pieces.  This  was 
done  on  the  7th;  for  nine  days  afterwards  the 
temperature  remained  normal,  but  the  patient 
was  unconscious  for  most  of  the  time.  When 
the  unconsciousness  passed  off,  delirium  set 
in ;  he  disturbed  the  dressings,  fingered  the 
wound  and,  he  ih.ought,  inoculated  it.  The 
temperature  then  began  to  rise  and  went  up  to 
102.4^.  Althougli  carefully  redressed,  the  mis- 
chief seemed  to  have  been  done,  as  an  abscess 
developed  over  the  external  angular  process. 
In  the  subsequent  manipulations  entailed  by 
these  complications  another  fissure  fracture  was 
discovered. 

Dr.  Armstrf)ng  thought  the  interest  of  the 
case  was  chiefly  in  connection  with  the  man's 
future,  and  what  after    troul)le  of  a   cerebral 


nature  was  in  store  for  him.  He  asked  for  an 
expression  of  opinion  about  opening  the  mem- 
branes in  these  cases.  He  had  here  a  man 
decidedly  unconscious;  there  might  have  been 
laceration  of  the  braiii,  but  the  membranes 
were  intact  and  normal  and  pulsation  beneath 
was  distnct,  and  he  did  not  think  it  wise  to 
open  them  in  the  |)resence  of  a  possibly  septic 
wound. 

Dr.  James  Bell  regretted  not  iiaving  heard 
the  report  of  the  first  case.  In  the  second  case 
he  was  not  quite  clear  as  to  Dr.  Armstrong's 
descrij)tion  ;  he  would  like  to  know  if  portions 
of  the  bone  were  removed  and  afterwards  re- 
placed in  small  fragments,  and  which,  in  spite 
of  the  septic  condition  present,  retained  their 
vitality,  and  developed.  With  regard  to  the 
point  Dr.  Armstrong  wished  discussed,  he 
thought  it  was  very  hard  to  lay  down  any  rule 
in  such  cases  ;  it  was  a  question  to  be  decided 
upon  at  the  moment,  and  under  the  circum- 
stances he  felt  that  he  should  have  acted  as 
Dr.  Armstrong  had  done.  There  being  no 
localizing  symptoms  uithin  the  membranes 
pointing  to  any  particular  aiea,  and  consider- 
ing the  danger  of  introducing  sepsis,  he  could 
not  see  that  any  other  course  lay  open  to  the 
careful  surgeon.    . 

Dr.  Ar.mstrong,  in  answer  to  Dr.  Bell's 
question  reg.irding  the  replacing  of  the  i^ieces  of 
bone,  after  mentioning  the  dimensions  of  the 
whole  area  of  removed  bone,  said  that  several 
small  pieces  not  more  than  half  an  inch  square 
were  replaced,  and  as  he  had  seen  nothing  of 
them  since,  he  presumed  they  were  still  in  the 
wound.  The  wound,  however,  he  did  not 
believe  was  infected  until  later,  which  might 
remove  that  obstacle  to  union  taking  place.  At 
any  rate,  the  fragments  were  there  as  far  as  one 
could  feel,  and  appeared  to  be  good  firm  bone. 

Seborrhcea. — Dr.  J.  M.  Jack  read  a  paper  on 
this  subject. 

Dr.  Shepherd  said  that  he  must  acknowledge 
himself  .lisappoinied  with  the  paper ;  he  expect- 
ed something  more  modern.  This  was  seborr- 
hea and  its  treatment  of  twenty  years  ago  which 
Dr.  Jack  had  given.  The  latter  had  said  nothing 
of  the  micro-organisms  which  caused  the 
disease,  nor  of  seborrhoea  congestiva,  nor  of 
Unna's  theories  with  regard  to  the  sudoripar. 
ous  glands,  all  of  which  he  had  been  in  hopes 
of  hearing  and  getting  fresh  light  upon.  The 
most  imi)oriant  thing  for  the  general  practi- 
tioner to  remember  was  that  seborrhica  was  apt 
to  run  into  eczema,  and  it  was  sometimes  hard 
to  draw  the  line  between  the  two  conditions. 
\Vith  reg.ird  to  the  general  treatment,  it  was 
not  hard  to  treat,  tiie  diagnosis  being  once 
made.  In  the  first  place,  seborrhoea  ought 
never  to  be  diagnosed  from  the  scalp  eruption 
alone,  the  body  ought  also  to  be  stripped  and 
examined,  and  often  what  first  appeared  a  se- 
borrhoea would  turn  out  to  be  a  psoriasis.   As  to 


THE   CANADA    MEDICAL   RECORD. 


277 


the  treatment,  he  thought  the  germicidaltreat- 
inent  by  far  the  best,  and  he  beheved  that  micro- 
organisms were  always  at  the  bottom  of  the 
trouble.  Cases  occurred  in  the  robust  as  well 
as  in  the  weak;  common  dandruff  was  seborr- 
hoea.  Stborrhoea  often  spread  from  the  head 
all  over  the  body,  and  could  be  treated  only  by 
germicidal  remedies.  He  himself  preferred 
mercurial  treatment  to  all  others.  The  remark- 
able results  obtained  by  treating  seborrhcea  of 
the  scalp  with  the  oleates  of  mercury,  especially 
where  it  had  gone  on  to  the  congestival  stage, 
I  ad  often  been  observed  by  his  students,  past 
and  present,  at  the  General  Hospital  clinics. 

Dr.  G.  Gordon  CaxMPBEll  believed  ■  that 
general  treatment,  in  most  forms  of  skin 
disease,  was  only  needed  when  the  general 
health  needi  d  it.  Dr.  Campbell,  in  Dr.  Shep- 
herd's absence  last  summer,  had  conducted  his 
skin  clinic,  and  as  he  had  seen  so  aiuch  treat- 
ment by  mercurial  ointments  in  seborrhcea,  he 
thought  it  a  good  opportunity  to  try  other 
forms.  In  almost  every  case  he  found  he  had 
to  fall  back  on  the  mercurial,  and  had  to  use 
it  strong.  The  oleate  of  mercury  which  he  was 
accustomed  to  use  was  i  to  8  or  i  to  20.  Dr. 
Shepherd  prescribed  3  to  i.  He  certainly, 
therefore,  agreed  with  Dr.  Shepherd  that  there 
was  nothing  like  mercury  for  getting  a  speedy 
effect. 

A  JS'eiv  Form  of  Ether  Inhaler.  —  Dr. 
James  Bell  exhibited  an  aluminium  cone, 
which  he  described  thus  : 

This  inhaler  consists  of  an  aluminium  cone 
of  suitable  size,  made  without  seam  or  rough- 
ness, covered  with  stockinette,  within  which, 
on  the  inner  surface  of  the  cone,  is  placed 
some  gauze  or  absorbent  cotton.  The  advan- 
tages claimed  for  it  are,  first,  that  it  is  perfectly 
clean,  and  may  be  sterilized  as  a  whole  by  dry 
heat.  The  gauze  and  stockinette  covering  are 
renewed  for  each  patient.  The  aluminium  is 
of  course  not  absorbent  and  is  malleable,  so 
that  the  edges  may  be  moulded  to  fit  any 
peculiar  conformation  of  face.  It  possesses 
the  advantages  of  a  clean  folded  napkin  which 
can  be  sterilized  before  using,  and  which  is  the 
simplest  form  of  inhaler,  with  the  additional 
advantages  of  having  sufficie.it  consistence  to 
maintain  its  form  and  shape. 

We  are  apt  to  forget  thai  ether  is  not  a  sup- 
porter of  respiration,  and  that  while  we  add 
ether  vapor  to  atmospheric  air,  it  is  of  the 
utmost  importance  that  we  should  provide  for 
the  enlrauce  of  pure  air  into  the  respiratory 
organs  during  anaesthesia.  T  he  Clover  inhaler, 
which  is  now  so  much  in  vogue,  possesses  all 
the  disadvantages  which  it  is  possible  for  an 
ether  inhaler  to  possess.  It  has  but  one  re- 
deeming feature, —that  is,  it  economizes  ether, 
— a  small  matter  when  we  consider  the  welfare 
of  the  patient.  It  is  impossible  to  cleanse  it. 
Patients  go    on,  one  after    another,    respiring 


through  the   same  filthy    mask  and   the  same 
rubber    bag,    each    one  adding   his    quota    of 
mouth  secretions,  perhaps  syphilitic,  cancerous 
or     tubercular.     Tubercle    bacilli    must    fre- 
quently be  deposited  upon  its  walls,  and  vomited 
matter  saturates  it  from   time  to    time,  not    to 
speak  of  the  absolute   impossibility    of  steriliz- 
ing   the   mouth-piece  to  correspond  with    the 
precautions  which  we  take   with   all  the  other 
substances  coming  into    close  contact  with  the 
field   of  operation.     In    operations   upon    the 
face,  head  and  neck  this  is  of  vital  importance. 
I  have  had  many  years    of  experience  with  the 
Clover  inhaler,  and  I  am  convinced  that  even 
in  the  most  careful  hands  it  is  a  dangerous  in- 
s'rument  ;  needless  to  say    it  is  much  more  so 
in  the  hands  of  the  careless  or  inexperienced. 
It  is  an  asphyxiating  machine,  and  o.ilyin  prO' 
portion  as  it   asphyxiates    does    it   economize 
ether.     (If  used  without  the  rubber  bag  it  pos- 
sesses no  advantage  over    the    ordinary  cone.) 
The  patient  respires    the    same    air   over   and 
over  again  from  a  rubber  bag,  the   respired  air 
passing  through  a  ch  mber  containing  ether  in 
the  liquid  form.     It  is  only  as  the  ether   be- 
comes   vaporized    that    it    enters    the     system 
through  the  pulmonary  mucous  membrane  and 
produces  its   effects    on     ths    neive    centres. 
Should  the  rubber  bag  be  kept   appUed,  an»S' 
thesia  is    more  rapidly    produced,  because    in 
addition  to  ether  anaesthesia  there  is  asphyxia- 
tion by  carbon  dioxide.      {"he  answer  is  made, 
however,  by   adherents  of  the  Clover  inhaler, 
that  the  patient  should  be  allowed  a  breath    of 
fresh  air  at  every  third  or  fourth  inspiration.    I 
reply  that  he  should  have  pure  fresh  air  at  every 
inspiration;  and  if  he  does  not,  it  is  only  a  ques- 
tion of  degree  of  asphyxiation.     I  have  had,  as 
already  stated,  a  long  experience  with  the  Clover 
inhaler;  I  have   had,  I  am  sure,  very  serious 
after-results  from  its  use.  I  am  quite  certain  that 
in  many  of   ihe  cases  in  which   the  patient  be- 
comes livid,  and  in  which  the  bronchial  tubes  be- 
come filled  with  frothy  mucous,  these  results  are 
attributable    to  the  inspiration  of  impure  air. 
These  patients  generally  vomit  after  operation, 
and  are  very   slow  to    recover  consciousness. 
Where  ether  anaesthesia  has  been  produced  with- 
out asphyxiation,  even  when  maintaine  J  for  a 
couple  of  hours,  consciousness    is  rapidly  re- 
gained  after   the  administration    of  ether  has 
been   discontinued.     The  Allison  inhaler  and 
others  of  similar  construction  cannot  be  charged 
with  producing  asphyxia  ;  they  are  simply  un- 
clean, and  from  their  construction  it  is  impos- 
sible to  sterilize  them.     I  maintain  that  ether 
properly    administered    is    an    absolutely    safe 
anaasthetic.     Proper  administration  consists  in 
adding  to  pure  air  the  greatest  possible  amount 
of  ether  vapor.      It  must    never  be    forgotten 
that  ()ure  air  must  be  inspired  constantly,  and 
that  ether  vapor  is  not  a  supporter  of  liie,  and 
also  that  it  should,  as  a  rule,  be  given  in   as 


2-]% 


THE   CANADA   MEDICAL   RECORD. 


concentrated  a  form  as  possible.  Elher  dashed 
into  a  cone  vaporizes  mucli  more  quickly  than 
when  held  in  a  metallic  receptacle.  It  is  true 
that  ether  vapor  used  in  this  way  will  be  diff- 
used beyond  the  patient,  and  that  a  large  quan- 
tity of  it  will  be  wasted.  This  is  unavoidable, 
and  except  for  the  item  of  expense,  it  does  no 
harm.  Although  ether  vapor  is  inflammable, 
it  is  only  so  in  a  very  concentrated  condition, 
and  it  is  impossible  to  saturate  the  air  of  a 
room  sufficiently  to  ignite  ii  with  an  open  light. 
The  only  danger  of  ignition  is  in  the  immediate 
neighhorhocd  of  the  inhaler. 

It  seems  strange  that  with  the  knowledge  of 
bacteria  which  lias  been  accumulating 
for  years,  and  our  very  strict  precautions, 
based  upon  this  knowledge,  to  avoid  wound 
infection  in  surgical  operations,  that  there  has 
not  long  ago  been  devised  some  means  to  pro- 
vide an  aseptic  inhaler,  and  one  which  could 
be  cleansed  of  the  secretions  and  exhalations 
of  one  patient  before  applying  it  to  the  face  of 
another.  It  is  simply  horrible  to  contemplate 
the  use  of  a  Clover  inhaler  and  bag  which  has 
already  been  used  on  the  face  of  hundreds  of 
other  patients,  and  without  any  possibility  of 
l)roper]y  cleansing  it,  either  by  heat  or  chemical 
sterilizuion. 

Dr.  G.  G.  Campbell  said  that  the  first  point 
made  by  Dr.  Bell  in  favor  of  the  inhaler  de- 
scribed by  him,  and  one  on  which  he  laid  great 
stress,  as  being  an  advantage  lacking  in  other 
inhaleis,  was  that  it  could  be  sterilized.  Two 
years  before,  Dudley  Buxton,  of  London,  had 
perfected  a  Clover's  inhaler,  the  diffeient  parts 
of  which  could  be  taken  apart  and  sterilized. 
Dr.  Bell's  next  statement  was  that  ether  was 
not  a  supporter  of  respiration.  It  was  a  very 
important  point  to  remember  that  it  was  possi- 
ble to  asphyxiate  with  eiher.  Asphyxia  could 
be  produced  in  two  different  ways:  (i)  By 
replacing  the  oxygen  of  the  air  with  an  irrespir- 
able  gas,  such  as  nitrogen  or  ether,  and  then  it 
was  simply  want  of  aeration  of  the  blood  thai 
produced,  the  condition.  (2)  By  replacing  it 
with  a  poisonous  as  well  as  irrespirable  gas, 
such  as  chlorine,  which  would  tlien  add  to  the 
effects  of  the  withdrawal  of  air  the  effects  of 
the  poison.  As  far  as  he  could  under.'-tand, 
the  great  argument  of  the  opponents  of  Clover's 
inhaler,  apart  from  the  question  of  unclea:;li- 
ness,  was,  that  it  was  very  dangerous  to  re- 
breathe  the  same  air,  as,  besides  being  depiived 
of  its  oxygen,  it  was  filled  with  poisonous 
materials  from  the  lungs  of  the  patient.  Dr. 
(Campbell  thought  he  could  show  that  the  whole 
of  tlie  possible  degree  of  asphyxia,  which  it 
was  claimed  was  produced,  must  be  due  to 
withholding  i)ure  air  and  not  to  any  poisonous 
materials  present.  Of  the  whole  amount  of  air 
in  the  lungs,  one-fifth  was  changed  at  each 
breath.  '1  his  fifth  was  the  vitiated  air  often 
referred  to  as  being  so  injurious    to  rebrcathe. 


That  it  differed  in  any  respect  from  the  air  left 
behind  it  at  the  close  of  expiration,  it  was 
absurd  to  contend.  If  a  person  was  breathing 
at  the  rate  of  twenty  to  the  minute,  suflicient 
pure  air  was  taken  into  the  chest  to  fill  it  only 
four  times  a  minute  (20  -^  1-5  =  4),  and  the  in- 
dividual was  thus  continually  breathing  the  bad 
or  vitiated  air  diluted  with  one-fifth  of  pure  air, 
or,  in  other  words,  a  mixture  containing  four- 
fifths  of  air  loaded  with  impurities,  and  one- 
fifth  of  pure  air ;  ond  yet  was  not  suffering  from 
poisoning.  Furthermore,  if  the  person  did  not 
get  the  one-fifth  of  pure  air  every  breath,  or 
to  put  it  in  other  way,  four  chest-fulls  a  minute, 
asphyxia  of  greater  or  less  degree,  according  to 
the  extent  that  pure  air  was  withheld,  would  be 
produced.  What  Dr.  Campbell  wished  to 
make  clear  was  this  :  that  asphyxia  produced 
in  this  way  was  not  the  result  of  breathing  a 
poisoiious  gas,  but  was  the  result  of  not  getting 
sufficient  fresh  air  for  proper  aeration  of  the 
blood.  Suppose  the  person  to  be  breathing 
forty  to  the  minute,  he  would  get  as  much  good 
air  if  only  every  second  breath  was  pure  air,  as 
he  would  still  be  getting  the  foiirt  chest-fulls 
every  minute  ;  and  if  he  breathed  or  rebreathed 
the  already  respired  air  in  the  other  twenty 
breaths,  and  no  further  demand  was  made 
upon  him,  the  conditions  under  the  two  cases 
were  the  same.  The  fear  that  seemed  to  be 
constantly  present  with  some  men,  of  allowing 
their  patients  to  breathe  any  of  this  so-called 
poisonous  gas,  might  be  in  some  measure  re- 
moved, if  they  remembered  that  the  air  in  their 
own  lungs  contained  constantly  four  fifths  of  it. 
By  giving,  as  he  did,  two  breaths  of  pure  air  to 
every  one  fr^ini  the  bag  in  usmg  Clover's 
inhaler,  he,  Dr.  Campbell,  thought  it  could 
easily  be  seen  that  the  patient  was  getting  as 
much  good  air  a  minuie  as  in  quiet  breathing, 
when  it  was  remembered  that  the  rate  of 
breathing  was  twice  as  rapid  as  normal. 

Dr.  Campbell  considered  the  aluminium  an 
improvenent  on  the  ordinary  cone  for  the  rea- 
sons stated  by  Dr.  Bell,  and  that,  in  the  ab- 
sence of  better  apparatus,  ether  could  be  given 
well  by  a  cone,  i)rovided  it  was  administered 
slowly  at  first  and  the  amount  gradually  in- 
creased. Asphyxi.i,  however,  could  be  pro- 
duced by  replacing  too  much  of  the  air  breath- 
ed  by  ether  vapor  as  well  as  by  respired  air. 

Dr.  F.  \V.  C.-VMPBELL  had  had  an  opportu- 
nity of  examining  this  inlialer  a  few  weeks  be- 
fore, through  the  courtesy  of  the  manufacturer. 
It  seemed  to  him  a  very  admirable  one.  His 
experience  with  ancestheiics  was  extensive. 
There  was  no  doubt  that  liie  old-fashioned  cone 
was  an  abominable  thing  to  use  from  the  point 
of  view  of  cleanliness,  and  this  one  seemed  a 
very  great  improvement.  It  had,  however,  one 
disadvantage,  it  did  not  pack  easily  in  the  sur- 
gical bag.  However,  it  struck  him  tiiat  in 
using  Dr.   Bell's  arrangement  of  packing  with 


THE  CANADA  MEDICAL  RECORD. 


279 


cotton  it  would  hold  very  liitle  ether.  It  was 
in  this  respect  much  better  than  the  sponge, 
which,  when  it  became  saturated,  allowed  the 
ether  to  overflow. 

Dr.  Kenneth  Camkron  considered  the  alu- 
minium cone  a  decided  improvement  on  the  old 
red  flannel  one,  but  he  had  to  protest  against 
Dr.  Bell's  stiictures  on  ('lover's  inhaler.  The 
great  objection  raised  was  that  the  patient  was 
re-brealhing  his  own  poisonous  exhalations,  but 
he  felt  ihat  the  eiher  vapor  disinfected  this 
vitiated  air.  Having  had  experience  with  both 
forms,  he  considered  that  the  Clover  inhaler 
gave  the  greater  satisfaction,  when  properly 
used,  for  with  it  the  patient  could  be  more 
rapidly  anaesthetized,  the  amount  given  could 
be  regulated,  and  the  after-effects  in  his  ex- 
perience were  not  severe,  while  with  the  cone 
the  patient  breathed  air,  either  saturated  with 
ether  or  containing  no  ether  at  all.  It  was  his 
practice  always  to  stay  with  the  patient  until 
there  was  some  sign  of  reluming  consciousness, 
such  as  opening  the  eyes,  or  putting  out  tlie 
tongue  when  lo'.d  to  do  so,  and  this  period 
varied  from  five  to  twenty  minutes,  never 
longer.  He  therefoie  felt  that  when  the  anses- 
theiist  onre  fully  understood  the  use  of  Clover's, 
he  would  not  willingly  give  it  up  in  favor  of 
any  other  form  of  inlialer. 

Dr.  GuRD  hardly  thought  it  ])Ossible  that 
anyone  who  had  used  Clover's  inhaler  many 
times  could  give  it  up.  \\  ith  it  the  amount  of 
ether  could  so  easily  be  regulated.  Dr.  Bell's 
objections  could  be  done  away  with  and  the 
advantages  of  Clover's  inhaler  yet  reta  ned  by 
simply  not  using  the  bag.  He  maintained  that 
almost  any  individual  could  be  anaesthetized, 
and  any  operation  carried  through  from  begin- 
ning to  end  without  using  the  bag.  In  the 
course  of  nearly  all  major  operations  there 
were  st;iges  when  very  little  ether  was  needed  ; 
if  deeper  anaesthesia  was  required  quickly,  the 
bag  was  useful  though  not  essential. 

Dr.  Alloway  protested  against  the  state- 
ment that  Clover's  inhaler  was  dangerous. 
Eiher,  like  many  other  drugs,  was  dangerous 
if  used  by  stupid  or  unskilled  persons,  quite 
independent  of  the  instiument  employed  in  its 
administration.  He  had  had  much  experience 
with  both  the  Clover  inhaler  and  the  cone ; 
from  the  former  he  had  never  seen  any  danger 
resulting,  although  such  had  often  been  the 
case  with  other  instruments.  His  exjjerience 
corrol)orated  the  a.^sertions  of  Dr,  Gurd,  and 
he  was  certainly  in  favor  of  using  the  inhaler 
without  the  bag.  At  the  same  time,  when  con- 
fident of  the  ability  of  the  anaesthetist,  even  with 
the  use  of  the  bag  he  had  no  anxiety.  Some 
patients  seemed  to  be  brought  under  the  in- 
fluence quicker  when  the  bag  was  used.  Allis' 
inhaler  was  one  of  the  cleanest  instruments 
used.  It  had  a  roller  laced  on  metal  bars,  and 
which  could  be  replaced,  leaving  only  metal  to 


cleanse.  -As  regarded  the  necessity  of  making 
the  Clover's  inhaler  more  cleansable,  this  was 
simply  a  matter  of  technique  ;  and  there  now 
was  one  coming  out  which  could  be  taken  to 
pieces  and  the  parts  sterilized. 

Dr.  Shephfrd  would  like  to  hear  something 
more  definite  about  the  cases  referred  to  by 
Dr.  Bell,  where  the  Clover  inhaler  proved  so 
dangerous.  He  had  certainly  seen  many  in- 
stances where  the  patient  seemed  in  danger 
from  the  use  of  the  cone,  but  never  any  when 
Clover's  inhaler  was  used  by  a  skilled  anaes- 
thetizer. 

Dr.  Bell  said  he  had  anticipated  some  dis- 
cussion on  his  paper,  and  the  result  had  more 
tlan  realized  his  anticipations.  First  in  reply 
to  Dr.  Gordon  Campbell's  arguments,  which 
he  regarded  as  pure  sophistry,  Dr.  Campbell 
said  a  new  Clover's  inhaler  was  coming  out, 
which  could  be  sterilized  as  completely  as  any 
rubber  goods  coidd  possibly  be.  'i'liat  was 
just  the  point  ;  ordinary  rubber  goods  could 
not  be  properly  sterilized.  They  could  not  be 
rendered  aseptic  by  heat  without  destruction, 
and  he  knew  of  no  chemical  substance  by 
which  this  could  be  accomplished  To  begin 
with,  there  were  one  or  two  fallacies  with  re- 
gard to  the  Clover  inhaler.  If  you  did  not  use 
the  bag,  you  certainly  had  an  instrument  on 
the  same  principle  as  the  cone.  In  the  cone, 
the  liquid  ether  was  poured  over  a  large  sur- 
face, and  vaporized  more  rapidly;  in  the 
other  case,  it  remained  in  a  metallic  reservoir, 
and  through  that  reservoir  the  air  was  insjiired. 
With  regard  to  the  indicator,  it  ii^.dicated  noth- 
ing more  than  that  a  certain  amount  of  air  was 
drawn  through  a  larger  or  smaller  orifice  into 
the  ether  chamber — the  wliole  of  the  semi-cir- 
cular orifice,  e  r  the  half  of  it,  or  the  quarter  of 
it.  It  did  not  take  into  account  the  air  re- 
ceived from  other  sources.  If  the  space  was 
one-half  open,  the  patient  had  to  inspire  more 
vigorously  to  get  the  necessary  air.  In  using 
the  instrument  without  the  bag  the  principle 
was  absolutely  the  same  as  with  the  cone,  with 
the  exception  that  the  ether  remained  in  liquid 
form,  over  which  the  air  passed,  whereas  in  the 
cone  it  was  absorbed  by  cotton  and  a  large 
amount  was  wasted.  With  regard  to  Dr.  Camp- 
bell's mathematical  problem,  without  going  in- 
to the  physiology  of  respiration,  the  fact  re- 
mained that  whether  there  was  i-5th  or  i  50th 
of  pure  air  in  each  inspiration,  it  was  these 
inspirations  that  sustained  life  ;  and  if  we  could 
•  only  get  half  the  amount  of  air  necessary  to 
sustain  life  we  were  badly  off.  This  was  a 
principle  recognized  in  the  construction  of  all 
public  buildings,  that  there  must  be  a  certain 
amount  of  air  space  for  each  individual.  So  in 
the  operating  room,  a  certain  amount  of  air  was 
required  to  sustain  the  patient  for  a  certain  in- 
terval, and  if  he  was  allowed  that  amount  in 
twice,  thrice  or  four  times  that  interval,  it  was 


280 


THE   CANADA   MEDICAL   RECORD. 


equivalent  to  closing  him  in  a  room  (which  had 
a  capacity  for  one  man  only),  with  two,  three 
or  four  others.  He  did  not  speak  of  vitiated 
air,  he  spoke  of  it  as  re-respiring  the  same  air 
— breathing  carbonic  dioxide,  and  noxious  ex- 
halations, that  wa^-,  breathing  impure  air  and 
preventing  the  influx  of  oxygen  fro.n  the  outer 
air.  As  regards  the  patient  breathing  twice  as 
rapidly,  that  was  another  fallacy.  He  did  not 
believe  a  paiieni  breathed  twice  as  rapidly,  un- 
less it  was  in  the  same  sense  as  a  pneumonia 
patient  breathes  twice  as  rapidly  as  in  health  — 
simply  because  he  was  being  asphyxiated. 

In  regard  to  the  practical  example  of  the 
bad  effect  of  ihe  Clover  inhaler,  he  color  of 
the  patient  often  showed  the  results  of  that 
apparatus,  and  the  operation  had  frequently  to 
be  sLopi)ed  for  the  time  being.  It  was  per- 
fectly clear  to  him  that  patients,  taken  one 
after  another,  respired  ether  through  the  cone, 
apart  from  such  accidents  as  spasm  of  the 
glotii?,  etc.,  with  less  danger,  and  never  devel- 
oped thai  dark  livid  color  fiequently  seen  when 
the  Clover's  inhaler  was  used 

In  answer  to  Dr.  F.  W.  Campbell's  ques- 
tion, as  much  cotton-wool  can  be  put  in  as 
required.  The  cone  i)assed  around  was  a 
sm.all  one,  and  contained  about  the  average 
amount  of  cotton. 

In  reply  to  Dr.  Alloway,  who  spoke  of  an 
accident  which  had  occurred  recently  in  New 
York,  he  did  net  know  the  particulars  of i that 
accident,  but  he  knew  of  many  accidents 
occurrmg  outside  of  New  York  through  the 
use  of  the  Clover  inhaler — no  fatal  ones  pro- 
bably, but  many  times  he  himself  had  been 
very  anxious  about  patients  during  the  admin- 
istration of  ether,  and  most  of  them  when  the 
Clover's  inhaler  was  used.  Dr.  Shepherd 
wanted  some  definite  cases  mentioned  ;  well  it 
was  within  Dr.  Shepherd's  recollection  that  the 
Clover  inhaler  was  introduced  into  the  General 
Hospital,  used  for  several  years,  and  then  dis- 
carded, and  did  not  re-appear  for  years.  The 
reason  was  this,  a  very  nearly  fatal  accident 
occurred,  and  when  it  was  investigated,  it  was 
discovered  that  the  anaesthetist  forgot  to  put 
«ther  into  the  reservoir.  Now,  it  is  absolutely 
impossible  for  any  man  to  administer  ether 
with  a  cone,  and  make  a  serious  mistake, 
unless  by  giving  too  much,  and  this  can  be 
done  with  any  instrument.  Ever)  body  knew 
that  eiher  might  be  given  to  such  an  extent  as 
to  jjaralyze  the  respiratory  centre  and  kill  the 
patient  without  any  untoward  accident  having 
occurred  in  any  other  way.  That  was  the 
only  possible  way  harm  could  be  done  by  the 
cone  ;  whereas  with  the  Cltjver  inhaler,  he 
might  forget  to  put  in  ether,  or  let  it  run  out, 
let  it  spill  out,  and  for  these  reasons  the  rela- 
tive danger  of  the  two  methods  of  giving  ether 
was,  as  Dr.  Alloway  put  it  a  few  moments  ago, 
a  matter  depending  largely  upon  the  ability  of 


the  anaesthetist,  the  Clover  inhaler  being  espe- 
cially dangerous  in  unkilled  or  careless  hands. 
In  regard  to  his  remarks  on  vomiting.  Dr. 
Bell  referred  to  the  vomiting  following  the 
anaesthesia,  and  in  his  experience  he  found 
vomiting  far  more  frequent  after  the  use  of  the 
Clover  inhaler.  With  regard  to  Allis'  inhaler 
he  had  nothing  to  say,  except  that  it  was  not 
clean  ;  it  was  the  rubber  part  that  he  objected 
to.  An  essential  part  of  it  was  composed  of 
rubber,  and  this  could  not  be  cleaned,  much 
less  made  sterile,  as  sterilization  is  understood 
in  a  surgical  sense.  In  dealing  with  open 
wounds,  it  was  not  only  very  important  to  have 
clean  instruments,  but  in  many  serious  opera- 
lions  about  the  brain,  head,  face,  neck  and 
upper  extremity,  it  was  very  important  to  have 
an  inhaler  which  could  be  made  clean  and 
sterile,  and  put  into  the  hands  of  a  man  who 
had  already  sterilized  his  hands,  clothing,  etc. 
He  was  sure  there  was  no  surgeon  present 
who  had  not  felt  the  inconvenience  of  this  rub- 
ber bag  flopping  about  the  head  and  neck 
while  these  parts  were  being  operated  upon. 

Dr.  Shepherd  said  that  in  the  General 
Hospital  case  referred  to.  Dr.  Bell,  the  anaes- 
thetist, should  have  been  discarded  and  not 
the  inhaler. 

Dr.  G.  Gordon  Campbell  explained  that 
all  the  rubber  portions  of  Clover's  inhaler 
could  be  boiled  without  injury,-  provided  that 
they  were  put  on  in  cold  water  and  not  allowed 
to  touch  the  bottom  of  the  boiler.  He  always 
sterilized  his  own  in  this  way. 

ANfERICAN    DERMATOLOGICAL 
ASSOCIATION. 

Nineteenth  Annual  Meeting  of  the  above 
Association  will  be  held  at  the  Windsor  Hotel, 
Montreal,  on  September  tjth,  i8th  and  19th, 
1895.  O/jficers  for  \%<)e^:  President,  S.  Slier- 
well,  M.b.,  Brooklyn  ;  Vice-President,  J.  A. 
Fordyce,  M.D.,  New  York;  Secretary  and 
Treasurer,  C.  W.  Allen,  M.D.,  640  Madison 
Avenue,  New  York. 


Sco^ress    of    ^cteitce. 

THE    TREATMENT   OF  CYSTITIS 

Bv  GARDNiiR   W.   Allen,    M.D.,    of  Boston, 

Mass. 

'The  following  observations  are  based  on  the 
records  of  a  number  of  cases  wliich  have  come 
to  my  notice  within  the  last  eight  years.  I 
have  little  to  say  of  rare  or  severe  forms  of  ves- 
ical disease,  and  shall  consider  chiefly  the  treat- 
ment of  the  ordinary  run  of  urinary  symptoms 
met  with  in  out-patient  and  office  practice  ;  but 
the  commonplace  in  medicine  is  not  always  the 
least  important. 


THE   CANADA    MEDICAL    RECORD. 


281 


Most  of  the  cases  were  of  goiiorrhoeal  origin, 
and  in  nearly  all  the  inflammation  was  confined 
to  the  neck  of  the  bladder.  Extension  hack- 
ward  of  gonorrhoea  into  the  neck  of  the  blad- 
der, accompanied  by  a  sharp  onset  of  urinary 
symptoms,  is,  of  coarse,  coram  )n  enough.  In 
non-gonorrhceal  cases  the  cause  of  the  cystitis 
is  not  always  clear,  but  in  a  certain  number  is 
apparently  traceable  to  a  pjsterior  urethral 
catarrh  resulting  from  congestion  of  the  pros- 
tatic portion,  with  or  without  inflammation  of 
the  seminal  vesicles,  and  brought  about  by  pro- 
longed and  repeated  sexual  excitement.  It 
begins  insidiously,  has  little  or  no  tendency  to 
recover,  and  is  apt  to  be  difiicult  to  manage. 

As  regards  the  treatment  of  cystitis,  of  the 
various  internal  remedies  I  prefer  the  saline 
diuretics,  especially  benzoate  of  sodium.  Few 
surgeons  nowadays,  however,  would  long  defer 
local  treatment  of  the  disease.  For  the  simple 
purpose  of  washing  out  the  bladder,  perhaps  a 
saturated  solution  of  boric  acid  gives,  on  the 
whole,  the  best  results.  For  the  purpose  of 
producing  a  decided  impression  upon  the 
mucous  membrane  of  the  vesical  neck  I  have 
had  very  gratifying  experience  with  nitrate  of 
silver  and  permanganate  of  potassium.  I  have 
tried  various  other  substances,  but  not  to  a  suf- 
ficient extent  to  furnish  data  of  any  value. 

Nitrate  of  silver  is,  of  course,  familiar  to  all, 
and  I  suppose  is  more  used  than  anything  else 
in  the  deep  urethra,  and  deservedly  so,  for  it  is 
probably  the  most  valuable  remedy  we  have. 
It  is,  therefore,  so  well  known  and  has  been  so 
much  written  about  that  little  need  be  said  of 
it  here.  I  will  merely  remark  that  I  use  a 
milder  solution  than  formerly,  rarely  going 
above  one  per  cent.,  but  usually  inject  rather 
more,  that  is  to  say,  ten  or  fifteen  minims 
instead  of  four  or  five.  I  think,  also,  that  these 
injections  are  much  more  effectual  if  imme- 
diately preceded  by  the  passage  of  a  large 
sound,  except  in  the  more  acute  cases. 

Permanganate  of  potassium,  so  far  as  I  know, 
has  not  been  very  extensively  used  in  the  blad- 
der,— at  least,  I  do  not  remember  having  seen 
the  reports  of  it-i  use.  I  have  employed  it  a 
good  deal  in  the  last  six  years  with  great  satis- 
faction in  cystitis  and  chronic  prostatitis,  and 
reported  some  cases  four  years  ago.  Where  it 
fails,  nitrate  of  silver  often  succeeds,  and  vice 
versa. 

The  bladder  should  be  thoroughly  irrigated 
with  the  permanganate  solution,  and  this  is  con- 
veniently done  by  means  of  a  large  Ultzmann 
syringe  (which  has  a  capacity  of  about  five 
ounces)  connected  with  an  elastic  or  soft  rub- 
ber catheter.  One  syringeful  at  a  time  is 
injected  and  allowed  to  flow  out  again,  and  so 
on  until  the  solution  comes  away  with  as  bright 
a  color  as  it  went  in  ;  then  two  or  three  ounces 
are  injected  and  left  in  the  bladder,  which  the 
patient  should  hold  as  long  as  he    comfortably 


can.  It  does  not  seem  to  me  necessary  to  have 
the  eye  of  the  catheter  just  in  the  deep  urethra 
during  the  injection,  as  advised  by  Ultzmann 
and  others  ;  if  it  projects  a  little  beyond,  it 
seems  to  serve  the  purpose  as  well.  The  fluid 
apparently  settles  down  into  the  neck  of  the 
bladder  as  the  i)aiient  walks  about,  and  exerts 
a  stimulating  and  astringent  action  on  the 
mucous  membrane  ;  this  is  cliecked,  however, 
before  it  has  time  to  become  irritating,  by  the 
decomposition  of  the  solution,  which  takes 
place  as  soon  as  a  small  quantity  of  fresh  urine 
is  secreted.  It  is  well  to  begin  with  a  solution 
of  about  I  to  4,000  or  5,000;  weaker  than  this 
is  useless  on  account  of  its  rapid  decomposition. 
It  may  be  increased  at  the  next  sitting,  gener- 
ally after  an  interval  of  four  to  six  days,  to  a 
strength  of  i  to  3,000.  For  the  third  and  sub- 
sequent injections  a  r-lo-2, 000  solution  maybe 
used,  if  well  borne.  The  treatment  is  a  mild 
and  safe  one,  but  is  more  troublesome  to  carry 
out  than  the  instillations  of  silver  nitrate.  If 
good  is  to  result,  it  is  soon  apparent,  and  if 
there  is  no  improvement  after  a  few  injections 
it  might  as  well  be  abandoned. — Coll.  and  Clin. 
Record. 


ACUTE  INFANTILE  ARTHRITIS  IN 
THE  HIP. 

To  recapiiulate,  the  primary  causative  factor 
in  acute  arthritis  is  to-day  believed  to  consist  of 
an  acute  infection  of  pyogenic  micro-organisms. 
This  infectious  matter  may  enter  through  any 
damaged  surface  of  skin  or  mucous  membrane 
or  any  subcutaneous  phlegmon.  Other  predis- 
posing causes  may  also  exert  an  influence.  Of 
these,  traumatism  acts  principally  to  determine 
in  which  joint  the  affection  shall  manifest  itself. 
The  injury  may  be  a  slight  one,  and  trauma- 
tism acts  less  frequently  in  the  hips  than  in  the 
more  exposed  joints.  I'he  infectious  diseases, 
scarlet  fever,  measles,  chicken-pox,  variola,  ty- 
phoid fever,  and  parotitis  may  accompany  or  pre- 
cede an  attack  of  acute  arthritis  ;  their  role  is 
still  very  imperfectly  understood,  and  the  same 
may  be  said  of  tuberculosis  and  syphilis.  They 
may  act  either  in  making  easy  the  entrance  for 
the  pyogenic  germs,  or  in  reducing  the  patient's 
capacity  for  destroying  and  eliminating  them. 
Since  specific  germs  of  typhoid  fever  have  been 
found  during  the  fever,  both  in  osteomyelitic 
marrow  and  joint  pus,  it  is  possible  that  the 
typhoid  bacillus  may  occasionally  be  a  pyogenic 
factor.  Tuberculosis  and  syphilis  may  predis- 
pose to  the  affection.  An  acute  infectious  sup- 
purative synovitis  without  lesion  of  bone  may 
also  simulate  very  closely  what  is  usually  regard- 
ed as  the  ordinary  form  of  acute  arthritis. — 
Augustus  Thorndike  in  Bosto/i  Med.  and  Surg. 
Journ. 


252 


THE   CANADA    MEDICAL   RECORD. 


EYE  STRAIN  A  CAUSE  OF   NOCTUR- 
NAL   ENURESIS. 

Dr.  G.  M.  Gould  gives  the  details  of  five  cases, 
in  which  the  enuresis  was  cured  after  glasses 
were  fitted  and  the  eye  strain  removed.  IJesides 
these  cases  he  had  others  in  which  he  was  moder- 
ately cerlain  that  the  eyes  were  the  ullimale  or  a 
contributing  cause  of  the  affection  under  discus- 
sion, but  in  whicli  the  cure  was  either  more 
slow  or  the  etiology  more  suspicious,  and  he  did 
not  include  tliem  in  this  report. — George 
M.  Gould,  in  Phil.  Med.  News. 

BACTERIOLOGICAL  EXAMIN.VJTONS 

OF  DIPHTHERIA  IN  THE  UNITED 

STATES. 

This  paper  is  a  report  of  the  results  of  the 
bacteriological  study  of  diphtheria  in  the  United 
States  up  to  May,  1894.  Some  of  the  more 
important  conclusions  may  be  summarized  as 
follows  : 

1.  The  H  alth  Department  of  New  York  has 
undertaken  the  bacteriological  examination  of 
all  cases  of  suspected  diphtheria  in  that  city, 
unless  objection  is  made  by  the  attending  phy- 
sician, or  unless  it  is  not  deemed  advisable  to 
disturb  the  patient  by  such  examination.  The 
methods  employed  are  described  in  detail. 
During  the  year  ending  May  4.  1894,  cultures 
were  made  from  5,611  cases  of  suspected  diph- 
theria. The  results  have  proven  satisfactory, 
and  are  utilized  not  only  for  diagnosis,  but  also 
to  control  the  supervision  and  isolation  of  the 
cases. 

2.  Of  6,156  cases  of  suspected  diphtheria  in 
New  York  and  Boston,  58^  per  cent,  were 
proven  bacteriologically  to  lie  true  di[)htheria 
— or,  if  we  include  only  those  cases  in  which 
the  bacteriological  examination  was  considered 
to  be  entirely  satisfactory — of  5,340  cases,  67^ 
per  cent,  were  true  diphtheria,  'i'hese  were 
pseudo-membranous  inflammations  of  the  throat 
and  air-passages  uncomplicated  for  the  most 
part  with  scarlet  fever. 

3.  At  least  80  per  cent,  of  the  cases  of  mem- 
branous croup  in  New  York  were  diphtheria, 
and  only  14  per  cent,  were  shown  not  to  be 
diphtheria. 

4.  Fifteen  cases  of  fibrinous  rhinitis  an  1  4 
cases  of  primary  and  exclusively  nasal  diphthe- 
ria were  all  due  to  the  diphtheria  bacillus. 

5.  Various  forms  of  a  typical  diphtheria, 
many  without  membrane,  and  with  the  char- 
acters of  simp'c  catarrhal  angina  and  follicular 
tonsillitis,  are  described. 

6.  Instances  of  unusual  localizations  of  the 
diphtheria  bacillus,  as  in  the  middle  ear,  in 
wounds,  ulcers,  abscesses,  conjunctiva),  lungs, 
heart-valves,  and  the  distribution  of  the  bacilli 
in  autopsies  of  human  beings  and  of  guinea-pigs 
dead  of  diphtheria,  are  described. 

7.  The   various    bacteria    found   associated 


with  the  diphtheria  bacillus,  the  most  important 
pathogenic  forms  being    streptococci,  staphylo. 
cocci,  and  thediplococcus  lanceolatus,  are  con 
sidered. 

8.  In  general  the  great  majority  of  cases  of 
pseudo  membranous  anginas  in  scarlet  fever  are 
due  to  strejitococci ;  but  where  diphtheria  is  pre- 
valent and  opportunities  are  favorable  for  ex- 
posure to  diphtheria,  a  large  proportion  may  be 
due  to  the  diphtheria  bacillus.  The  statistics 
in  Baltimore  and  in  Boston  present  interesting 
contrasts  in  illustration  of  this  point.  Four 
cases  of  diphtheria  complicating  typhoid  fever 
are  described. 

9.  The  name  pseudo  di|)htheria  is  applied  to 
pseudo-membranous  inflammations  of  the  throat 
and  air-passages  not    caused  by  the   diphtheria 
bacillus.     The   most   im|jortant    and   common 
micro  organism     in    pseudo-diphtheria    is     the 
streptococcus  jjyogenes,  but  other  bacteria  m  ly 
be  the  cause.     The  mortality  in  these  affections 
is  low  in  private  practice,   being  1.7  per  cent, 
in  408    consecutive  cases  in    New    York.     In 
hospitals    it  may  be  as  h'gh  as    25  per  cent. 
Death  is  generally  due  to  some  comjjlication, 
the  most  important  complications  being  scarlet 
fever,    membranous    laryngitis,    and  broncho- 
pneumonia.    The  disease    seems  to    be    only 
slightly,  if  at  all,  contagious.     For  this  reason, 
and  on  account  of  the  low  mortality  in  uncom- 
plicated cases,  those  cases  which  are  proved 
bacteriologically  not  to  be  true   diphtheria  are 
not   kept    under    supervision    by    the  Health 
Department  in  New  York.     Until  such  proof, 
suspicious  cases  are  treated  as  diphtheria. 

10.  Of  752  cases  of  diphtheria  in  New  York, 
the  di[)htheria  bacilli  in  325  disappeared  with- 
in three  days  after  the  complete  disappearance 
of  the  exudate.  In  427  cases  the  bacilli  per- 
sisted for  a  longer  time,  viz.  :  in  201,  for  from 
five  to  seven  days  ;  in  84,  for  twelve  days;  in  69, 
for  fifteen  days;  in  57,  for  three  weeks;  in  11, 
for  four  weeks;  and  in  5,  for  five  weeks.  lu 
one  case,  virulent  bacilli  were  found  seven  weeks 
after  disappearance  of  the  exudate.  The  cases 
are  kept  under  supervision  until  the  bacilli  have 
disappeared.  Sometimes  they  disappeai  first 
from  the  r.ose;  at  other  times,  first  from  the 
throat 

11.  In  fourteen  families,  with  forty-eight 
children,  where  little  or  no  isolatioi  of  a  case 
of  diphtheri.i  in  each  family  was  undertaken, 
virulent  diphtheria  bacilli  were  found  in  50  per 
cent,  of  the  children,  of  whom  40  per  cent,  later 
developed  diphtheria.  The  bacilli  were  found 
in  less  than  10  per  cent,  of  the  children,  in 
families  wlure  the  case  of  dipht!ieri.i  was  well 
isolated. 

Antise[)iic  irrigation  and  cleansing  treatment 
of  tlK  throat  lessens  the  liability  of  those  thus 
exposed  to  develop  dtplitheria. 

All  members  of  an  infected  household  should 
be  regarded    as    under    suspicion,    and  where 


THE   CANADA   MEDICAL   RECORD. 


283 


isolation  is  not  enforced,  the  healthy  as  well  as 
the  sick  should  be  prevented  from  mingling 
with  others  until  cultures  or  sufficient  lapse  of 
time  give  the  presumption  that  they  are  not 
earners  of  contagion. 

]  2.  Diphtheria  bacilli  may  be  present,  and 
multiply  in  the  throat  without  causing  symp- 
toms or  lesions.  They  must  find  susceptibility 
to  their  pathogenic  action  in  order  to  cause 
diphtheria. 

13.  In  three  hundred  and  thirty  persons 
who  gave  no  history  of  direct  contact  with 
diphtheria,  virulent  diphtheria  bacilli  were 
found  in  eight,  of  whom  only  two  subsequently 
developed  diphtheria.  Bacilli,  indistinguish- 
able morphologically  or  in  cultures  from  the 
diphtheria  bacillus,  including  the  f)rmation  of 
acid  in  forty-eight  hours  in  bouillon,  but  entirely 
devoid  of  virulence,  were  found  in  twenty-four 
of  these  persons,  in  most  of  these  instances  in 
large  numbers.  The  pseudo-diphtheria  bacillus 
was  found  in  twenty-seven. 

14.  Instances  are  given  in  w'lich  the  diph- 
theria bacilli  were  found  on  vaiious  objects  out- 
side of  the  human  body,  viz.,  bed-clothing 
soiled  with  discharges  of  diphtheria  patients  ; 
the  shoes  and  the  hair  of  nuises  in  attendance 
on  diphtheria  patients,  and  a  brush  used  in 
sweeping  the  floor  of  a  diphtheria  ward. 

15.  Some  of  the  various  ways  in  which  the 
diphtheria  germ  is  transported  are  summarized. 

16.  A.  bacillus  in  no  way  distinguishable  in 
morphology  or  in  cultures,  including  the  forma- 
tion of  acid  in  bouillon,  from  the  usual  diph- 
theria bacillus,  but  devoid  of  virulence,  exists. 
The  virulence  was  tested  by  injecting  into 
half-grown  guinea-pigs  ^  to  i  percent,  of  their 
weight  of  forty-eight  hour  bouillon  cultures. 
This  bacillus,  although  it  has  been  called  by 
some  investigators  the  pseudo-diphtheria  bacil- 
lus, should  not  be  so  designated.  It  is  the 
genuine  diphtheria  bacillus  devoid  of  virulence. 
It  was  met  with  in  a  com.paratively  small  num- 
ber of  cases  out  of  a  large  number  examined. 
Exceptionally,  it  may  occur  together  with 
the  virulent  diphtheria  bacillus  in  diphtheria, 
and  occasionally  it  takes  the  place  of  the 
virulent  bacillus  during  or  after  recovery  from 
diphtheria.  In  several  instances  it  was  found 
in  healthy  throats. 

The  name  pseudo-diphtheria  bacillus  should 
be  confined  to  bacilli,  which,  although  resem- 
bling the  diphtheria  bacillus,  differ  from  it  not 
only  by  absence  of  virulence,  but  also  by  cul- 
tural peculiarities,  the  most  important  of  the 
latter  being  greater  luxuriance  of  growth  on 
agar  and  the  preservation  of  the  alkaline  reac- 
tion of  bouillon  cultures.  The  pseudo-diph- 
theria bacillus  may  render  bouillon  cultures 
acid  in  forty-eight  hours  when  grown  anaero- 
bically.  The  pseudo-diphtheria  bacillus  in  this 
sense  was  found  in  a  number  of  cases,  but  not 
frequently.     It  is.  probably  of  different  specieg 


from  the  genuine  diphtheria  bacillus,  and  is 
without  diagnostic  importance. — Wm.  H. 
Welch  in  Am.  Jotirn.  Mai .  Sc. 

TREATMENT  OF  DIPHTHERIA. 

The  conclusions  derived  from  this  series  of 
cases,  together  with  investigation  and  observa- 
tion on  a  much  larger  number  of  cases,  lead  us 
to  believe  : 

1.  That  frequent  washing  of  the  air-passages 
attacked  by  diphtheria  lessens  the  duration  and 
mount  of  diphtheritic  membrane. 

2.  The  addition  of  antiseptics,  in  sufficient 
strength  to  be  germicidal,  to  the  irrigating  fluid 
is  irritating  to  the  mucous  membrane,  thereby 
causing  extension  and  persistence  of  false 
membrane  rather  than  the  effect  desired. 

3.  The  addition  of  antiseptics  to  the  irrigat- 
ing fluid  is  liable  to  cause  systematic  poisoning 
and  disagreeable  complications  from  the  swal- 
lowing and  absorption  of  some  of  the  fluid  used, 
e.g.^  the  two  bichloride  cases  cited  above. 

4.  Spraying  the  throat  (also  the  pernicious 
treatment  of  swabbing)^  whatever  solution  is 
used,  can  have  no  good  effect,  as  the  parts 
reached  by  the  spray  must  necessarily  be  very 
limited,  excepting  possibly  in  the  hands  of  an 
expert.  Furthermore,  the  spray  cannot  be  used 
with  young  children,  as  anyone  can  testify  who 
has  tried  it.  'I  his  is  especially  true  of  some 
solutions  where  it  is  necessary  to  use  a  glass 
syringe. 

5.  Frequent  cleansing  of  the  throat  and 
nasal  cavities  with  a  bland  solution,  such  as 
plain  warm  water  or  normal  salt  solution,  is 
easier  of  application^  is  more  agreeable  to  the 
patient,  and  does  all  that  any  antiseptic  solu- 
tion can  accomplish,  either  upon  duration  of 
the  membrane  or  the  period  of  isolation. — A. 
Campbell  White  in  Med.  Rec,  N.Y. 

DIPHTHERIA  IN  ITALY. 

The  author  presents  an  interesting  statistical 
study  of  diphtheria  in  Italy  for  the  years  1887 
to  1892  inclusive.  During  that  period  the 
number  of  deaths  fell  "from  24,637  to  13,434, 
the  smallest  number  being  12,284  in  1890, 
The  disease  is  very  unevenly  distributed 
throughout  the  peninsula,  the  mortality  ranging 
from  1.8  per  10,000  in  the  marshes  to  15.8  per 
10,000  in  the  province  of  Basilicata.  The 
mortality  in  the  country  districts  is  much 
higher  than  that  in  the  cities.  As  regards 
seasons,  the  disease  prevails  especially  in  the 
winter,  the  mortality  figures  for  the  four  seasons 
being  as  follows  :  Winter,  10,945;  spring, 
9,293 ;  summer,  7,315;  autumn,  8,320.  The 
greatest  number  of  deaths  occurred  in  children 
between  one  and  five  years  of  age,  the  prepon- 
derance of  males  over  females  being  very 
slight. — ACHiLLE  ScLAVO  in  Gazzdia  degli 
Ospedali  edclle  C7inic/ic,  October  20,  1894. 


284 


THE   CANADA   MEDICAL   RECORD. 


AN  ANOMALOUS  CASE  OF 
DIPHTHERIA. 

The  patient  was  a  boy,  aged  thirteen  years, 
and  on  the  second  day  of  the  sickness  the 
exudate  appeared  on  both  tonsils,  with  a 
temperature  early  in  the  day  at  107^'.  On  the 
morning  of  the  next  day  his  teinpeiature  ran  up 
to  110°,  and  at  this  time  his  throat  became 
entirely  clear  of  membrane,  but  he  developed 
all  the  symptoms  of  acute  cerebro-spinal 
meningitis,  pain  in  the  head,  with  head  drawn 
back,  pupils  dilated,  and  for  forty-eight  hours 
he  was  raving  crazy,  laboring  under  high 
maniacal  excitement. 

During  all  of  this  time  his  pulse  was  nearly 
normal.  He  presented  all  the  evidences  of  a 
person  suffering  from  a  highly  septic  condition. 
When  the  cerebro-spinal  symptoms  subsided 
the  entire  fauces  became  covered  with  diphthe- 
ritic exudate. 

At  this  time  also  the  patient  lapsed  into  a 
condition  of  stupor,  bordering  upon  coma,  but 
there  was  no  time  but  that  he  could  be  readily 
aroused.  At  this  stage  of  his  sickness  there  was 
also  a  marked  crisis,  and  the  patient  came  very 
near  succumbing  to  heart  failure.  There  was 
evidence  of  a  weakened  heart's  action  for  weeks 
afterwards. 

The  day  following  the  subsidence  of  the 
cerebro-spinal  symptoms,  there  was  a  peculiar 
bad  odor  from  the  body,  the  abdomen  became 
mottled  and  dark  colored,  there  were  profuse 
discharges  of  diphtheritic  membrane  from  the 
bowels,  accompanied  with  very  painful  tenes- 
mus, and  it  looked  as  though  we  were  destined 
to  have  a  fatal  termination  from  septicaemia. 
At  one  period  the  respiration  was  somewhat 
affected,  though  not  seriously.  At  no  time  was 
the  function  of  the  kidneys  impaired  in  the 
least. 

The  throat  gradually  cleared  up,  and  all  dan- 
gerous symptoms  subsided,  tliough  the  conval- 
escence was  slow  on  account  of  the  weakened 
heart's  action.  At  one  time  the  left  parotid 
gland  became  inflamed  and  swollen,  but  did  not 
suppurate. — Theo.  L.  Hatch  in  Northwest. 
Lancet.,  St.  Paul,  1894. 

* 
THE  IMMUNIZATION  OF  CHICKENS 
AGAINST  THE  DIPHTHERITIC  BA- 
CILLUS, AND  THE  PASSAGE  OF  IM- 
MUNIZING SUBSTANCES  WITHIN 
THEIR  EGGS. 

It  is  well  known  that  chickens  and  pigeons 
are  very  susceptible  to  the  di])htheriiic  bacillus. 
The  author  communicated  to  the  Royal  Acad- 
emy of  Medicine  of  Turin  some  interesting  ex- 
periments carried  on  to  see  whether  these  fowls 
could  be  protected.  He  was  successful  in  his 
endeavors,  both  by  the  Fiankel  method  (virus 
attenuated  by  high  temperature)  and  the  method 
of  Behring  (trichloride  of  iodine).     He   also 


succeeded  in  establishing  immunity  by  injectio  ns 
of  filtered  cultures  of  graduated  strengths. 
Most  interesting,  however,  is  the  fact  that,  in  a 
certain  number  of  hens  so  treated,  he  invariably 
found  that  the  eggs  possessed  an  immunizing 
property,  which  is  manifested  both  by  the 
albumen  and  the  yolk.  He  diluted  small  quan- 
tities of  egg  with  equal  amounts  of  normal  salt 
solution,  and  succeeded  in  immunizing  guinea 
pigs  with  this  preparation. 

The  author  is  now  investigating  whether 
guinea  pigs  may  be  immunized  by  feeding  them 
with  eggs  thus  obtained. — Sclavo  in  Gazz 
clcgli  OspcJali,  July  14,  1894.  Am.  Med. 
Surg.  Bull..,  1894. 

TREATMENT  OF    DIPHTHERIA  AS 
INDICATED  BY  ITS  ETIOLOGY 
AND  PATHOLOGY. 

For  local  treatment  the  best  results  are  ob- 
tained from  peroxide  of  hydrogen.  He  gener- 
ally dilutes  it  to  twice  its  volume,  and  renders  it 
alK aline  shortly  before  using  with  the  bicarbon- 
ate of  sodium,  and  sprays  the  parts  thoroughly 
every  hour  until  the  throat  and  nose  are  clear 
and  the  membrane  disappears. 

He  has  had  good  results  from  the  internal 
use  of  turpentine,  but  alcohol  and  food  are  the 
most  important  aids.  He  reports  a  successful 
case  after  the  use  of  Behring's  antitoxin. — J.  B. 
Casello,  in   Cincinnati  Lancet. 

CLASS-ROOM  NOTES. 

—  Tuberculosis,  according  to  Prof.  Keen, 
may  be  introduced  into  the  system  through 
wounds  of  the  skin,  such  as  a  scratch  or  bruise, 
which  generally  escape  notice.  It  is  not 
necessary  in  such  a  case  that  a  patient  be  pre- 
disposed to  tuberculosis. 

— Prof  Hare  gives  the  following  prescription 
of  Peabody  in  cases  of  Headache  due  to 
Ancemia  : — • 

5.         Acid,  salicylic, 

Ferri  pyrophosphat, 
Sodii  phosphatis, 
Aquce  deslillat., 

SiG.-^— This  amount  to  be    taken 
hours. 

— Prof.  Wilson  says  that  in  cases  of  Influ- 
enza, catarrhal  pneumonia  occurs  insidiously, 
with  a  gradual  intensification  of  the  bronchitic 
symptoms  on  about  the  fourth  or  fifth  day  as  a 
rule,  but  it  may  set  in  as  early  as  the  second 
day  or  also  during  the  time  of  convalescence. 

— Arsenic,  in  the  form  of  Fowler's  solution, 
Prof.  Hare  says,  is  a  standard  remedy  \\\ 
chronic  gout.  It  should  be  administered  with 
perfectly  pure  water,  or,  better,  lithia  water. 
If  an?emia  be  present,  it  should  especially  be 
used,  and  with  it  may  be  given  cod-liver  oil  and 
the  syrup  of  the  iodide  of  iron. 


gr- 

XXX 

gr- 

v 

gr. 

) 

ss. 

M. 

n  every 

three 

THE   CANADA   MEDICAL    RECORD. 


285 


THE  CANADA  MEDICAL  RECORD 

Published  Monthi.v. 


Sul'S'Tiptioii  Price,  $1.00  per  annum  in  adiiance.     Sinyle 
Co/lies,  K)  c^v. 

EDITORS : 

A.  LAPTHORN  SMITH,  B.A.,M.D.,  M.RC.S.,  Eng.,  F.O-S. 

London. 
F.  WAYLAND  CAMPBELL,  M.A.,  M.D.,  L.RCP     London 

ASSISTANT  EDITOR 
EOLLO  CAMPBELL,  CM.,  M.D- 

Make  all  Cheques  or  P.O.  Money  Orders  for  subscription  or 
advertising  payable  to  JOHN  LOVELL  &  SON,  23  St.  Nicho- 
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should  be  addressed. 

All  letters  on  professional  subjects,  books  for  review  and 
exchanges  should  be  addressed  to  the  Editor,  Dr.  Lapthorn 
Smith,  248  Bishop  Street. 

Writers  of  original  communications  desiring  reprints  can 
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Editor. 


MONTREAL,  SEPTEMBER,  1895. 

CHANGE  OF  MANAGEMENT. 

In  this  number  of  the  Canada  Medical 
Record,  which  is  the  last  of  the  present  volume, 
we  have  an  important  announcement  to  make 
to  our  readers.  Owing  to  the  ever-increasing 
demands  which  his  hospital  and  other  duties  are 
making  upon  his  time,  Dr.  Lapthorn  Smith 
has  been  compelled  to  retire  from  the  manage- 
ment, which  will  be    taken  by  Dr.  McConnell. 

The  Record  will  be  greatly  enlarged  and 
divided  into  departments  which  will  be  under 
the  editorial  charge  of  well  known  specialists, 
who  will  make  it  their  aim  to  keep  their  readers 
thoroughly  au  coiirant  of  all  that  is  going  on  in 
iheir  specially,  by  means  of  quarterly  retro- 
spects, on  Medicine,  Surgery,  Gynsecology,  Ob- 
stetrics, Therapeutics,  etc.  Under  the  new 
management  the  journal  will  appear  promptly 
on  the  1 8th  of  each  month,  and  the  proceedings 
of  the  Medico  Chirurgical  Society  will  appear 
in  the  number  following  the  meeting,  for  which 
purpose  they  will  be  specially  reported,  and 
all  the  members  taking  part  in  the  discussions 
will  receive  equal__ attention.  Our  modesty  pre- 
vents us  from  reminding  our  readers  of  the 
many  reforms  to  which  the  Record  has  lent 
its  influence,  but  we  believe  that  the  esteem 
in  which  it  is  held  by  its  subscribers,  from 
many  of  whom  wc;  have  received  letters  full  of 
encouragement,  renders  it  unnecessary  to  say 
that  it  has  always  done  what  it  could  to  pro- 
tect  the  interests    of  the   profession   at  large. 


The  Record  will  be  increased  in  size,  but  not- 
withstanding the  great  expense  which  this  will 
entail,  the  price  will  remain  as  before,  the  ex- 
tremely low  one  of  one  dollar,  in  advance. 

THE    CANADL'VN    MEDICAL    ASS'JCLV- 
TION. 

The  Kingston  meeting  of  the  above  Associa- 
tion, under  the  presidency  of  Dr.  William 
Bayard  of  St.  John,  N.B.,  was  an  unqualified 
success.  The  attendance  was  one  of  the  largest 
in  its  history,  and  was  especially  remarkable 
for  its  representative  character,  there  being 
present  leading  men  from  nearly  every  pro- 
vince, although  on  the  other  hand  there  were 
fewer  from  the  surrounding  country  than  usual. 
This  must  be  explained  in  the  same  way  as 
the  smallness  of  the  attendance  of  local  men 
when  ihe  Association  meets  in  Toronto,  namely, 
by  the  apparently  stronger  claim  which  the 
Ontario  association  makes  to  the  practitioners 
throughout  that  province,  an  attendance  of 
two  hundred  being  nothing  (inusual.  The 
profession  of  Kingston  did  much  more  than 
could  reasonably  have  been  expected  of  them 
in  the  way  of  entertainments,  for  in  addition 
to  numerous  lunches  and  dinners  and  visits  to 
institutions,  there  was  a  very  enjoyable  excur- 
sion through  the  world  famous  "  Lake  of  a 
Thousand  Islands  "  on  the  beautiful  steamer 
"  America,"  and  on  which  a  generous  supper 
was  served.  In  the  opinion  of  some  this  was 
the  best  part  of  the  meeting,  as  it  brought  toge- 
ther in  social  intercourse  men  whose  names 
were  well  known,  and  many  of  these  acquaint- 
ances may  in  time  ripen  into  life-long  friend- 
shi{)s.  Many — in  fact,  most — of  the  papers 
were  of  a  high  order  of  merit,  and  it  was  some- 
what unfortunate  that  more  of  them  were  not 
got  through  with  on  the  first  two  days,  as 
during  the  last  day  the  audience  is  apt  to 
diminish  considerably.  The  address  of  the 
veteran  President,  Dr.  William  Bayard,  was  a 
masterly  paper,  and  was  well  received  not  only 
by  the  audience,  but  was  favorably  commented 
upon  by  the  lay  Press  of  the  Dominion.  He 
gave  much  wise  advice  on  three  important 
points  :  the  abuse  of  medical  charity  ;  the  over- 
education  of  the  masses;  and  the  abuse  of  alco- 
hol. Indeed,  we  consider  what  he  said  on 
these  topics  of  such  paramount  importance  to 
the  profession  and  to  the  people  of  the  Domin- 


286 


THE  CANADA  MEDICAL  RECORD. 


ion  al  large,  that  we  shall  take  an  early  oppor- 
tunity of  publishing  the  address.  Tliere  is  no 
doubt  tliat  year  by  year  the  class  of  well-to-do 
people,  who  could  afford  to  pay  a  physician, 
r.nd  yet  who  frnudiilently  obtain  his  services  for 
nothing,  is  greatly  increasing,  nnd  it  is  quite 
time  that  something  should  be  done  about  it. 
We  shall  discuss  this  subject  in  a  future  editor- 
ial. Our  two  distinguisiied  medical  and  surgi" 
cal  knighis,  Sir  James  Grant  and  Sir  William 
Hingslon,  were  present,  and  contributed  not  a 
little  to  the  interest  of  the  meeting.  They 
were  among  the  few  of  its  founders  who  are 
still  alive,  and  m:iy  justly  be  called  the  fathers 
of  the  Association.  One  of  the  others,  Dr. 
Thorburn,  of  Toronto,  was  elected  President  for 
the  ensuing  year,  and  will  preside  at  the  meet- 
ing in  Montreal  next  August. 

We  cannot  in  justice  to  Dr.  Starr  close  these 
remarks  without  testifying  to  his  great  zeal  and 
energy  as  Secretary  General,  which  contributed 
so  greatly  to  the  success  of  the  meeting.  As 
long  as  Dr.  Starr  liolds  that  position  we  can 
count  upon  having  a  ful!  programme  for  every 
session. 

MUNICIPAL   CONTROL  OF  UNNECES- 
SARY NOISES. 

Dr.  Augustus  Clarke,  of  Cambridge,  Mass., 
read  a  very  opportune  paper,  at  the  recent 
meeting  of  the  Amjrican  Medical  Association, 
on  the  question  of  state  or  municipal  control 
of  artificial  agencies  wliich  produce  unneces- 
sary noises.  Anyone  living  in  a  large  city, 
especially  if  his  nervous  system  has  been 
highly  developed  by  education,  must  often 
have  suffered  acutely  from  the  unnecessary 
noises  with  which  his  ears  are  constantly 
assailed.  At  one  moment  it  is  a  man  shouting 
"  coal  oil  "  hundreds  of  limes  in  a  distance  of 
as  many  yards  ;  ano'.her  shouting  "  bananas  ;" 
then  a  Scotch  coal  cart  comes  tearing  down 
the  street,  creating  a  frightful  din.  On  streets 
paved  witii  cobble-stones,  as  many  streets  are> 
tlie  unnecessary  noises  are  multiplied  tenfold. 
Then  there  is  the  hurdy-gurdy  man,  and  on 
the  main  streets  the  dreadful  clanging  of  the 
electric  street  car  bells,  which  make  a  great 
deal  more  noise  than  there  is  any  need  for- 
The  cars  themselves,  owing  to  the  roughness 
uf    their    machinery    and    the    lack  of  care, 


a|)p  uently,  in  seeing  that  it  works  smoothly, 
cause  still  more  noise.  3o  that  those  who 
have  the  misfortune  to  have  their  homes 
located  on  any  of  these  streets  or  lines  of 
travel  are  condemne"d  to  loss  of  sleep,  which 
often  means  loss  of  health  ;  then  the  sick,  for 
whose  benefit  ihe  medical  profession  exists, 
suffer  still  more  acutely  from  these  unnecessary 
noises.  At  present  it  appears  that  there  is  no 
control  over  them  whatever  :  the  coal  cart  boy 
can  bang  and  rattle  his  cart  over  the  stone 
pavements  ;  and  the  hurdy-gurdy  man  can 
grind  his  dreadful  organ  ;and  that  banana  man, 
witii  his  bananas  at  ten  cents  a  dozen,  can 
keep  on  making  life  not  worth  living,  'without 
anyo  ie  having  the  right  to  interfere.  Should 
anyone  in  desperation  throw  boiling  water  on 
them,  he  would  of  course  become  amenable  to 
the  law.  So,  as  Professor  Clarke  says,  "  have 
not  the  minority  of  the  people  who  thus  suffer 
some  vested  rights  that  the  majority  ate  bound 
to  respect?  Surely,"  he  remarks,  "the  per- 
sons to  whom  the  physician  for  ihe  most  part 
is  summoned  to  treat  belong  to  this  latter 
class." 


PERSONALS. 

At  a  recent  meeting  of  the  Trustees  of  Jeffer- 
son Medical  College,  Philadelphia,  the  honorary 
degree  of  LL.D.  was  conferred  on  Dr.  John 
Collins  Warren,  Professor  of  Surgery  in  Har- 
vard University. 

At  a  recent  meeting  of  the  Faculty  of  Bishop's 
College  Dr.  Lapihorn  Smith  was  appointed 
Professor  of  Clinical  Gynaecology. 


BOOK  NOTICES. 

Practical  Dietetics,    with  special  reference 
to  diet  in  disease.     By  W.  Oilman  Thomp- 
son,  M.D.,  Professor  of  Materia  Medici, 
'I'herapeutics,  and  Clinical  Medicine  in  the 
University  of  the  City  of  New  York;  Yisit- 
ing    Physician    to  the    Presbyterian  and 
Bellevue    Hosi)itals,    New    York.     Large 
octavo,    eight  hundred  pages,  illustrated. 
Price,  doih,  $5,00;  sheep,  $6.00.     Sold  by 
subscription  only.    D.  Appleton  &    Co., 
publishers,   72   Fifth   A\e.,  New  York. 
The  subject  i-.    one  which  does  not  receive 
proper  alitnlion  eiihcr  in  medical  colleges  or  in 
the  standard  works  upon  the  Theory  and  Prac- 
tice  of    Medicine,    the  directions  given    in   the 
latter  being  of  a  very  general  and  vague  charac- 
ter, and  in  the    former  it  is  dismissed  in  one  or 


THE  CANADA  MEDICAL  RECORD. 


2S7 


two  lectures.  In  hospitals  and  in  the  training 
of  nurses,  too  little  attention  is  paid  to  tlie  sub- 
ject, while  in  works  on  food  and  dietetics  the 
practical  application  of  dietetics  to  disease 
receives  but  slight  notice.  This  work  is  intended 
to  remedy  these  shortcomings,  and  to  furnish 
to  the  practitioner  a  texl-book  containing- 
instructions  as  to  the  appro|iriate  diet  in  dis- 
eases which  are  influenced  by  right  feeding. 

Beginning  with  the  elementary  com])Osition 
of  foods,  the  author  next  classifies  them,  and 
takes  up  in  succession  force  production  and 
energy  ;  the  force-producing  value  of  the  differ- 
ent clnsses;  stimulating  foods;  their  economic 
value  ;  a  compai  ison  of  the  nutritive  properties 
of  animal  and  vegetable  foods ;  and  vegeta- 
rianism. The  classes  of  foods  are  next  consid- 
ered, including  water,  salts,  animal  and  vege 
table  foods,  fats,  and  oils.  In  the  section  on 
animal  foods  much  attention  is  given  to  the 
subject  of  milk  in  all  its  forms — pure,  adul- 
terated, prepared,  etc. — in  accordance  with  the 
great  imporiance  of  the  article  so  commonly 
used.  Stimulants  and  beverages,  with  their 
good  ;ind  ill  effects,  their  comparative  values, 
administration  and  varieties,  are  fully  and 
carefidly  considered. 

The  vario "S  methoJs  of  cooking  food  are 
given,  with  the  effect  of  each  method  on  the 
different  classes  ;  also  the  means  used  for  con- 
densing and  preserving  foods.  In  the  article 
on  foods  that  are  required  for  special  conditions, 
the  author  takes  up  food  in  its  relation  to  age, 
individual  size,  b-^  dy  weight,  sex,  diet  and  here- 
dity, diet  and  race,  and  climate  and  season. 
Proper  attention  is  paid  to  the  subject  of 
digestion  and  the  conditions  which  especially 
affect  it.  The  au;hor  considers  the  general 
relations  of  food  to  special  diseases  ;  those  that 
are  caused  by  dietetic  errors  and  the  adminis- 
tration of  food  for  the  sick,  giving  the  neces- 
sary ru'es  as  to  method,  time,  etc.  Dietetic 
treatment  in  fever  in  general  is  followed  by 
instructions  for  diet  in  specified  diseases,  with 
lists  of  food  suitable  for  the  patient  in  certain 
stages  of  the  disease,  as  in  the  infectious  fevers 
and  other  acute  affections. 

The  work  abounds  in  analytical  tables  giving 
the  percentages  of  ingredients  in  the  various 
animal  and  vegetable  foods  ;  standards  for  daily 
dietaries  as  influenced  by  age  and  occupation  ; 
the  energy  developed  by  a  given  quantity  of 
certain  foods  ;  diet  tables  representing  a  ration 
as  issued  in  the  army  and  navy  under  different 
conditions ;  and  also  those  used  in  various 
prisons  and  reformatory  institutions. 

The  feeding  of  jjiegnant  women,  nur.-,ing 
moiheis,  infants,  and  young  children  consti- 
tutes a  very  important  part  of  the  work,  and 
an  appendix  contains  receipts  for  invalid  food 
and  beverages  suitable  for  fevers  and  convales- 
cence from  acute  illness. 

The  work  gives  much  evidence  of  careful  and 


intelligent  observation  on  the  part  of  the  author, 
and  v/ill,  the  publishers  believe,  be  found  to  fill 
a  field  heretofore  practically  unoccupie  I.     It  is 
a  book  which  will  he  fi)und  to  be  of  great  assis- 
tance :o  the    practitioner  in  the  dietetic  treat- 
ment of  diseases  that  are  influenced  by  proper 
feeding,  invaluable  to  the  trained  nurse  in  hos- 
pital and    private  nursing,  and  of  inestimable 
service    as  a   guide  in    the    administration  of 
proper  food  to  infants  and  invalids  in  the  home. 
Green's  Pathology  and  Mot<r.iD  Anatomv. 
Pathology  :<,nd   Morbid  Anatomy.   By  T. 
Henry      Green,      M.D.,      Lecturer     on 
Pathology  and  Morbid  Anatomy  at  Char- 
ing-Cross  Hospital  Medical  School,  Lon- 
don.    Seventh  American  from    the  eighth 
and  revised  English  edition.     Octaso  vol- 
ume of    595   jjp.  ,  with    224     engravings, 
and  a  colored  i)late.     Cloth,  $2.75.     Phil- 
adelphia, Lea  Brothers  &  Co.,  publishers, 
1895. 
Green's  Pathology  and  Morbid  Anatomy 
has  long    been  the    leading  text  and    reference 
book  in  ail   English  speaking  countries,  a  fact 
indicated  by  the  number  of  editions  demanded. 
A  knowledge  of  the  su' ejects  covered  by  its  title 
is  essential  to  graduation  and  not  less  so  to  the 
practitioner,  who  must  understand  the    nature 
ofadisease  as  a  prerequisite   to  rational  cura- 
tive measures.     Thanks  to  the  tireless  industry 
of   laboratory   workers    and    clinicians,    these 
sciences  are  in  a  state  of  constant  development, 
and  in  order  to  represent  their  existin^^  position, 
this  volume  has  been  thorougiily  revised  and 
new  chajjters     have  been    added.     The    pre- 
viously rich    series    of   illuslratirjns    has    been 
increased  with  sixty  new  engravings. 


PAMPHLETS. 


Address  on  the  Founding  oe  the  Illinois 
HosPiiAL.  Delivered  in  Central  Music 
Hall,  June  12,  1895.  By  Seth  Scott 
Bishop,  M.D.,  Professor  of  Diseases  of  the 
Nose,  'I'hroat  and  Ear  in  the  Chicago 
Summer  School  of  Medicine;  Professor  in 
the  Post-Graduate  Medical  School  and 
Hospital,  Chicago.  Reprinted  from  the 
Journal  of  the  American  Medical  Associa- 
tion, June  29,  1895.  Chicago  :  American 
Medical  Association  Press.  1895. 

Reminiscences  of  Dr.  J.  Marion  Sims  in 
Paris.  By  Kdmond  Souchon,  M.D., 
Professor  of  Anatomy  and  Clinical  Sui- 
gery,  Tulane  University,  New  Orleans, 
La.  Reprinted  from  the  Medical 
Record,  December  8,  1894.  New  York 
Trow  Directory,  Printing  &  Bookbind- 
ing Co.,    201-213  East  Twelfth  St.  1894. 

Notes  on  a  Hitherto  Undescribed  Skin 
Disease.  Endemic  in  Central  America, 
called    by   the    natives  "  Bulpiss."     Oito 


THE  CANADA  MEDICAL  RECORD. 


Lerch,  Ph.D.,  M.D.,  Former  State  Geo- 
logist of  Louisiana,  etc.  Reprinted  from 
the  May,  1895,  N;;niber  of  the  New  Or- 
leans Medical  &  Surgical  Journal. 

What  Results  may  be  Expected  from 
Celiotomy  in  Insanity,  Hystero-Epi- 
LEPSY,  AND  Kindred  Neuroses.  Re- 
marks with  Illustrative  Cases.  By  VV.  P. 
Manton,  M.D.,  President  of  the  Detroit 
Academy  of  Medicine;  Vice-President  of 
the  American  Association  of  Obstetri- 
cians and  Gynrecologisls;  Gynecologist  to 
Harper  Hospital,  etc. 

Genital  Reflexes.  By  W.  P.  Manton, 
M.D. 

A  Case  of  Iiydatid  Tumor  of  the  Perito- 
neum. By  VV.  P.  Manton,  M.D.,  Gynae- 
cologist to  Harper  Hospital  ;  Consulting 
Gynaecologist  to  the  Eastern  and  North- 
ern Michigan  Asylums  and  St.  Joseph's 
Retreat,  etc.     1894,  Dettoit,  Mich. 

Gyn.txology  among  the  Insane,  from  the 
Gyn.ecologist's  Point  of  View.  By  VV. 
P.  Manton,  M.D.,  of  Detroit,  Mich., 
Consulting  Gyncecologist  to  the  Eastern 
and  Northern  Asylums  for  the  Insane, 
and  St.  Joseph's  Retreat;  Gynecologist 
to  Harper  Hospital,  etc.  From  the  Medi- 
cal News,  July  7,  1894. 

Case  of  Double  Pyo.salpinx.  By  Hunter 
Robb,  M.D  ,  Professor  of  Gynaecology 
Western  Reserve  University.  Reprint 
from  Western  Reserve  Medical  Journal, 
March,  1895. 

A  Successful  Case  of  Porro  Cesarean  Sec- 
tion (modified).  By  Hunter  Robb, 
M.D.,  Professor  of  Gyna^cobgy  in  the 
Western  Reserve  University.  Reprint 
from  Western  Reserve  Medical  Journal, 
May,    1895. 

Treatment  of  the  Opium  Neurosis.  By  Ste- 
phen Lett,  M.D.,  Medical  Siiperintendent 
of  the  Homewood  Retreat,  (iuelph,  Ont., 
Canada.  Read  in  the  Section  of  Medical 
lurisprudence  and  Neurology  at  the  Forty- 
second  Annual  Meeting  of  the  American 
^.  Medical  .Association,  held  at  Washington, 
D.C.,  May,  1891.  Reprinted  from  the 
Journal  of  the  American  Medical  Asso- 
ciation, November  28,  1891.  Chicago: 
published  at  the  office  of  the  Association. 
1891. 
Last  One  Hundred  Abdominal  Se  tiong  for 
Removal  of  Ovarian  Tumors  and  Dis- 
eased Uterine  Appendages.  By  R. 
Stansbury  Sutton,  M.D.,  IMtisburgh,  Pa. 
Reported  by  J.  P.  Hunter,  M.D.,  Alle- 
gheny, Pa.  Reprinted  from  the  Pittsburgh 
Medical  Review,  November,  1894.  Press 
of  Murdoch,  Kerr  &  Co.,  53  Ninth  St., 
Pittsburgh,  Pa. 


Surgical  Treatment  of  Tumors  of  the 
Neck.  By  Thomas  H.  Manley,  M.D., 
Visiting  Surgeon  to  tlie  Harlem  Hospital, 
New  York.  1894.  Reprinted  from  the 
Medical  Brief,  St.  Louis,  Mo. 


PUBLISHERS  DEPARTMENT. 

THE  LADIES'  HOME  JOURNAL 

PHILADELPHIA. 


A  Book  for  Voung  Mk.\. 
Edward  Bok,  the  editor  of  The  Ladies'  Home  Jour- 
nal, has  written  a  liook  for  young  men  called  "  Success- 
ward :  A  Young  Man's  Book  for  Young  Men,"  which 
the  Revells  will  publish  in  a  fortnight.  The  book  aims 
to  cover  all  the  important  phases  of  a  young  man's  life  : 
his  business  life,  social  life,  his  amusements,  religious 
life,  dress,  his  attitude  toward  women,  and  the  queUion 
of  his  marriage.     This  is  Mr.  Bok's  first  book. 

A   Horse-Show  Story. 

Mrs.  Burton  Harrison  has  written  a  new  novelette, 
dealing  in  the  main  with  the  "  fashionables  "  of  New  York 
at  the  Horse  Show,  which  The  Ladies^  Hovie  Journal  xs 
about  to  begin.  ^Ir.  W.  T  Smedley  has  illustrated  the 
story. 


AN.EMIC  PATIENTS  WHO  HAVE  MALARIAL 
CACHEXIA. 
Dr.  T.  D.  Crothers,  editor  of  'TAe  Quarterly  Jour- 
nal of  Inebriety,  published  under  the  auspices  of  The 
American  Association  for  the  Study  and  Cure  of  Inebri- 
ates, and  who  is  an  authority  on  neurosis,  writes  in  his 
last  number  as  follows  :  Anlikamniaand  Quinine  are  put 
up  in  taV)let  form,  each  tablet  containing  two  and  one- 
half  grains  of  antikamnia  and  two  and  one  hnlf  grain.;  of 
quinine,  and  is  the  most  satisfactory  imde  of  exhibition. 
This  combination  is  especially  valuabj^e  in  headache 
(hem-crania),  and  the  neuralgias  occurring  in  am^.nic 
patients  who  have  malarial  cache.via,  and  in  a  large 
number  of  aiT  ctions  more  or  less  dependent  upoithis 
C.l<.llc:Clic  coiidition. 


The  four  weekly  issues  of  Littell's  Living  Age  for 
September  are  replete  with  the  choicest  gleanings  of  the 
British  reviews  and  magiziiies.  Thes;  issues  contain 
twenty  seven  complete  papers,  many  of  them  of  great 
value  and  intense  present  interest. 

Among  the  more  valuable  essays  and  reviews  may  be 
particularly  mentioned,  ''  Norway  nnd  Sweilen,"  which 
is  really  a  "  double  star."  The  one  by  J.  E.  Sars,  Pro- 
fessor of  History  in  the  University  of  ihrtstiana,  pre- 
sents •' The  Case  of  Norwegian  Liberalism  ";  thesecond, 
by  Carl  Siewers,  reveals  "  A  King's  Scheme  of  Scandi- 
navian Uiulicaiion."  "  The  I'roblems  of  the  Far  East." 
the  leading  article  in  No,  2670.  is  an  able  review  of 
recent  works  by  such  writers  as  Hon.  Ceo.  P.  Curzon, 
M.P.,  Henry  Norman,  Chester  Holcombe  and  others, 
on  the  China  and  Japan  question.  Biogiaphy  is  repre- 
sented by  an  exceedingly  good  article  on  "  Huxley"  by 
P.  Chalmers  Mitclieil.  and  another  on  *'  Mrs.  Gaskell  " 
by  Mat  Hompes.  '•  The  .Spectroscope  in  recent  Chem- 
istry''  by  R.  A.  Gregory,  nnd  '"  .*>iars  and  Molecules" 
by  Rev.  Edmund  Ledger,  will  prove  of  great  interest  to 
the  general  as  well  as  the  scientific  reader.  '•  A  Visit 
to  Bonifacio"  by  J.  N.  Usher;  •' .\ntaictic  Explora- 
tions,"' (•'  In  Ihe^  New  Zealand  .\lps,"  '*  Poetic  Pride," 
"  Latter  Day  Pag.ms."  and  "  The  He.ivy  Burden  of 
Empire"  are  the  lilies  of  other  valuable  papers.  In 
fiction  each  number  contains  a  complete  .story,  ami  o( 
poi  try  a  full  i>age. 


I 


^  iJU 


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C358 
V.23 


Canada  medical  record 


GERSTS